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Psy340 Lec 2

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University of Toronto Mississauga
Hywel Morgan

January 15, 2013 Psy 340 – Lec 2 Assessment, Diagnosis and Treatment Based on the assessment, a diagnosis is made, and based on the diagnosis a treatment is made A problem with diagnosis is that it can be stigmatizing, since it is a label, and it sticks with the patient/client Even after the treatment has been issued, the assessment is still carried on (to see how the treatment is working) Assessment There are 3 types of assessment for psychopathology: 1. Interview - primary method of assessing an adult client 2. Observation - primary method of assessing children 3. Psychological testing - exclusive domain of psychologists Psychological testing If the test becomes useful, then other psychologists adopt it, companies that use the psychological tests will need to see a copy of doctorate of psychology degree to see that the psychologists is able to administer the test Ex/ WAIS is the whesler adult intelligence scale, most popular intelligence test, only licensed and qualified psychologists are able to use it Assessment > Referral The nature of the referral is important, gives clues on the client’s nature of the problem, their willingness to do something about it and what their basic symptoms are Ex/ Could be a nurse, social worker, nurse practitioner (can prescribe medication, can provide services in standalone position, under the presence of a physician), physician’s assistant (prescribe medication under the supervision of a physician) There has to be an acknowledgment in the referral that there is a problem—states that there is a behavior disorder and needs a proper assessment Referral can be done by any health practitioner Prognosis- the predicted course and outcome of the disease, what the disease could become Diagnosis- what the disease is If the referral comes from a physician or other health professional, that indicates that the person has sought out somebody voluntarily to deal with the particular problem they have, their motivation is high, and it means that they are willing to deal with the issue If the referral comes from the courts, the motivation level of the person is low, and they are not willing to deal with the problem In order to enhance the level of motivation, the judge can offer them choice (either go to jail or seek professional help) After a basic understanding of the issue there is a formal assessment Formal assessment It is an ongoing process The first initial formal assessment is a lengthy process, the procedure can be 3-4 hours long, but it can take up to many days as well-over this time, we are observing what the client is doing Clinical method of assessment > Clinical observations Watching what the client is doing--how they say what they say and what they do The warnings when we observe behavior is that we are observing the behavior in an artificial setting—this can cause anxiety from the client, this anxiety is behavior that the client wouldn’t normally show, and this behavior is shown only at one time (another problem), there could also be an observer bias due to the referral (since we know what we are looking for due to the referral, we may overlook other behaviors and focus on one target behavior we are biased to Valuable information of the observation of the client can be obtained in 4 categories Information can be gathered by looking at appearance and actions in the following 4 categories in clinical observation: 1. General appearance and attire – observing how the client presents themselves, just by meeting them, their physical, social and personality characteristics can be identified, there could be physical abnormalities, deformities, cleanliness, health—information on physical appearance can lead to gaining background information on the client Ex/ A lady who had bruises can be abused, she can do self harm, hard to distinguish between physical and mental disorder—could be epilepsy How they dress themselves and groom themselves can also provide information—does it fit their age and socio-economic status? 2. Emotional gestures and facial expressions (body language) – expressions or gestures may be subtle and should be carefully attended to Ex/ emotions include anger, fear, surprised, happiness, sadness, disgust The greater the anxiety, the more expressions we can observe. For an extremely anxious client, the anxiety needs to be addressed as quickly as possible, but how?  need to ask them why they are anxious directly, if they are not able to talk about their problem due to their anxiety then they have low motivation and we have a poor prognosis 3. gross and fine motor acts – affected by neurological, physiological, pharmalogical, there could also be extreme under activity of movement (catatonia –either lack of or too much movement, indicative of depression), there could be unusually ritualistic or compulsive disorders (OCD) Ex/ Parkinson’s disease is a neurological disorder, due to lack of dopamine, people with this disease have good reflexes, they have problem with the voluntary movements (motor cortex in the frontal lobe), have problems with the initiation and sensation of voluntary movements— hence the disease is a result from the decay of the substantia nigra region—they find it difficult to start and stop movements Ex/ Drug abuse can also lead to lots of movement 4. Verbalizations of the client – listening to the structure of their verbalizations, are the verbalizations appropriate for their age? Education? Socio-economic status? The structure of their verbalizations can give us an estimate of what their intelligence level is If a client is showing neologism—producing new words that don’t exist, this could be indicative of brain damage, psychosis or mental retardation Listening to the structure of the language, gives information on how the client thinks, how and what they have learned, gives information on the functioning of their memory (can they remember the past, are they making up things from the past, can they remember new information, if they are stating stuff that is not true but they are not lying—that is called a confabulation, or if they have hypernesia—remembering minute details from the past is indicative of OCD Clinical method of assessment > The interview Clinician is passively collecting information, in the interview questions are asked and verbal responses are expected, the interview is more formal The types of questions asked are generated from the information gathered from the referral The interview includes questions from the following 3 domains: 1. Identifying data – name, age, level of education, occupation, religious views 2. Primary complaint/s – the present problem/s 3. History – client’s and family’s history Ex/ If primary complaint is I stopped eating, I don’t find anything pleasurable, I sleep for long periods of time, then this could be indicative of depression, so it is important to consider if anyone in the family has depression—since depression does have a genetic basis Purpose of the initial interview is to gather diagnostic data and the other reason is to establish rapport—this is to establish a relationship with the client, a proper relationship leads to good assessment of the problem There are two basic types of interviews: 1. Structured – a set of questions that are pre determined and they are selected based on the referral, the interview is lengthy and covers all the basics however it is not good for building rapport 2. Unstructured – free to ask the client anything this leads to high rapport but there is low accuracy of information—may miss information There needs to be a balance between the two—established by separating important information from unimportant information Clinical method of assessment > psychological tests The tests have norm, offer degree of objectivity, provide quantification—measure behavior, assign a number to that behavior and that provides the measure of objectivity Can also gather information about the client that is not readily accessible from the interview or the observation There are two types of tests: 1. Cognitive tests – test how a person thinks, looks at verbal and visual-spatial functioning Ex/ WAIS intelligence test, IQ tests are the most common tests of intelligence WAIS looks at the information a person knows. An example of a question on the WAIS is: how many senators are in the US senate? ANS: 100 Criticism of the WAIS is that it is culturally biased, example for the above question, only Ame
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