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Lecture

Clinical Assessment and Diagnosis Lecture and reading notes (chapter 3) covering the topic of clinical assessment and diagnosis, detailing assessment and diagnosing techniques.

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Department
Psychology
Course
PSYCH 257
Professor
Uzma Rehman
Semester
Winter

Description
Clinical Assessment and Diagnosis January-16-11 12:41 PM 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 situation Assessing Psychological Disorders January-16-11 4:38 PM  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 relevant  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. o 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 descriptive validity.  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 construct validity.  The degree to which study results generalize to populations and contexts beyond the particular ones included in the study itself is external validity. o 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 expression. Thought process: how the person talks, structures their sentences, content, evidence of delusions, 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 they are o Unstructured interviews have no systematic format. Room for flexibility but not efficient at obtaining lots of information o Semi structured: somewhat formatted. Questions carefully phrased to elicit useful information. 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 Physical Examination  Particular attention paid to medical conditions sometimes associated with the specific psychological problem  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. Behavioural assessment  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 and experiences  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 patients' behaviour  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 Psychological Testing  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 he sees. 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.  Intelligence Testing: 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 being intelligent Neuropsychological testing  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 is suspected. 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
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