Lecture 2 Clinical Assessment and Diagnosis Jan 15th

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16 Aug 2010
Clinical Assessment:
x Aspects of Assessment
o Assessment is the process of gather information about the cause for his or her
problems. Current symptoms.
o Recent life events? Most forms of psychiatric disturbance often follows after a
negative life event.
o Physical problems? Someone may come with heart disease and come with a
secondary panic disorder.
o Focus on current drug and alcohol use. Can make problems that are their
much worse
o Family history: clinicians ask questions about other members of the family.
What might the other families be experiences
o Focus on the persons cognitive functioning.
o These are used together to contribute to making a diagnoses.
o Making an appropriate diagnose is important b/c: yoXGRQ¶WKDYHWRZDVWHKLV
or her time of a wrong problem. Treatment might not be targeted properly.
Many people who present one problem might have more than one problem.
The idea is see what the primary disorder is, and what are the others ones that
are appearing/showing up.
Types of reliability:
- It gets at the consistency of producing the same result with the same instrument.
- Test retest reliability: similar results at two points in time. One area is the that
this is important is IQ testing. To make educational decisions.
- Internal reliability: different parts of test produce similar results. Low internal
reliability: courts people get tired fatigued.
- Inter-rater reliability: two or more raters come to similar conclusions. Raters
could be two clinicians.
Types of validity
- Does this measure what it is designed to measure
- Face validity: appears to measure what it should measure
- Content validity: assesses all important aspects of phenomenon. E.g good IQ test
should have spatial reasoning, language comprehension, speed of thinking, all
measures included in the test. Included. potential for creative thinking, emotional
intelligence. Not included). The dimensions.
- Concurrent validity: test produces the same results as other similar measures.
- Predictive validity: test predicts behavior it is suppose to measure. E.g. test IQ to
see if the child should be placed in special education. LSAT low predictability
- Construct validity: test measure what it is supposed to measure. The big
- The application of certain standards or norms that have been achieved with the
instrument. Are there standards to ensure consistency across different
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x Clinical Interviewing
o Clinical interview is focused on current and past behaviors. Not only about
current symptoms it will move toward the narrow aspect of the persons past
behavior and current behavior, and of their presentation of their self. Key
categories with attention toÆ primary complaint. Life events that might have
preceded the onset of the problem. (interpersonal life events), quality of
interpersonal relationships? Family relations? Negative interpersonal
relationships can have a lot of stress. Psychiatric problems can be buffered by
positive social support. Studies show better outcome. Family functioning:
how does the family function. What is the structure of the family. Who issues
discipline. One parent or two. The script/identity of the person in the family.
How do other members of the family see this individual. Cultural issues:
certain psychiatric issues are more prevalent in certain cultures. The same
order can be expressed differently depending on the culture. Certain cultures
produce unique disorders. There are certain disorders only known in certain
cultures. E.g. Kora²only observed in Asian cultures.
o Formal interview with scoring components. The mental status examination.
(1) assessment of appearance and behavior (overt behavior/expression on
face/ presentation anxious/fidgety e.g. hunched over= depressed/agitated )
(2) thought processes (rate of speech/content of speech/ continuity of speech
(clear continuous or clear and then lowers and the pauses for 15 minutes)
(3) mood and affect (predominant feeling state of that person? Consistent
stable pattern of this person shows stable emotions over time) affect (emotion
expressed at a given point of time) how appropriate is the persons affect?
When having loss someone important for them, are they laughing, if
incongruence b/w expression of emotion and situation. The appropriateness of
emotion fits the expression. Or is the person showing no emotion at all.
(4) individual functioning: types of vocabulary (best predictor of IQ)
(5) sensorioum: awareness of patient surrounding? Do they know the date
time, or where they are.
This type of interview would likely to administer to those who have been
shown up in the ER hospital. Preliminary determination of what should be
followed up.
x Behavioural Assessment
o Formally assess peoples thinking and feeling patterns in a certain situations.
Naturalistic environments.
o The ABCs of observation:
Antecedents: factors that occur that either bring up or make the
problem worse. When and where were you when the symptoms begin
to occur. With whom? When does the problem not occur
Behavior: what is the actual problem. What is the person doing while
the problem is occurring. When someone is feeling depressed, a classic
behavioral response social withdrawal. Disengagement and giving up
on goals. Someone who is manic: overengages in new goal and does it
their thoughts and feelings that impact on their lives. These test are
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