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Lecture

PSYCH257 Lecture Notes - Psychopathy Checklist, Thematic Apperception Test, Inter-Rater Reliability


Department
Psychology
Course Code
PSYCH257
Professor
Uzma Rehman

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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

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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)
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