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Western University
Psychology 2030A/B

CHAPTER 3 1/22/11 7:19 PM CLINICAL INTERVIEW •Gathers information on current and past behaviour, attitudes, and emotions, as well as a detailed history of the individual’s life in general and of the presenting problem •Determine when the specific problem first started and identify other events that might have occurred about the same time •To organize info obtained during an interview, many clinicians use a mental status exam •When presenting one of these exams – importance of PATIENT’S TRUST and EMPATHY Mental Status Exam •Involves the systematic observation of somebody’s behaviour •Organize info in sufficient way to see if psychological disorder is present •The exam covers 5 categories: 1. Appearance and behaviour: •Overt behaviour •Attire (individual’s dress) •General appearance, posture, expression •Ex. Frank – persistent twitch, appearance appropriate 2. Thought process •Rate of speech •Continuity of speech •Does person make sense •Content of speech •Ex. Flow and content of speech reasonable 3. Mood and affect •Predominant feeling stat of the individual •Normal reactions to situations oLaughing if mother dies •Ex. Frank – anxious mood, affect appropriate 4. Intellectual functioning •Estimate of intelligence •Type of vocabulary •Use of abstractions and metaphors •Ex. Frank – intelligence within normal limits 5. Sensorium •General awareness of our surroundings •Do you know who you are? Where you are? Who they are> •Self, time and place •Ex. Frank – ORIENTED times three Semi structured Clinical Interviews •Unstructured interviews – follow no systemic format •Semi-structured interviews – made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner, so clinicians can be sure they have inquired about the most important aspects of particular disorders BEHAVIOURAL ASSESSMENT AND OBSERVATION •BA: measuring, observing, and systematically evaluating (rather than inferring) the client’s thoughts, feelings, and behaviour in the actual problem situation or context •Used for children who are no old enough or skilled enough to report their problems and experiences •Target behaviours are identified and observed with the goal of determining the factors that seem to influence those behaviours •Most clinicians assume that a complete picture of a person’s problems requires DIRECT OBSERVATION in naturalistic environments The ABC’s of Observation •Observational assessment is usually focused on the here and now – clinicians attention is usually directed to the IMMEDIATE behaviour, its ANTECEDENTS (or what happened just before the behaviour), and its consequences (what happened afterward) oAntecedents (exists before) oBehaviour (act) oConsequences (reaction) •Ex. Boy – 1) his mother asking him to put his glass in the sink (antecedent), 2) the boy throwing the glass (behaviour), 3) his mother’s lack of response (consequence) oThis ABC sequence might suggest that the boy as being reinforced for his violence outburst by not having to clean up his mess - b/c there was no negative consequence for his behavior (mother didn’t scold or reprimand him), he will probably act violent the next time he doesn’t want to do something •Ex of INFORMAL OBSERVATION – problem with this is the observer’s recollection as well as his interpretation of the events •FORMAL OBSERVATION – involves identifying specific behaviours that are observable and measurable oTarget behaviour, observer writes down each time it occurs, along with what happened just before (antecedent) and just after (consequence) oGoal is to see if there are any obvious patterns of behaviour and then to design a treatment based on these patterns PSYCHOLOGICAL TESTING •Must be reliable and valid •Include specific tests to determine cognitive, emotional, or behaviour responses that might be associated with a specific disorder and more general tests that asses long-standing personality features •Specialized areas include: oIntelligence testing – to determine the structure and patterns of cognition oNeuropsychological testing – determines the possible contribution of brain damage or dysfunction to the patient’s condition oNeurobiological procedures – use imaging to assess brain structure and function Projective Testing •Include a variety of methods in which ambiguous stimuli, such as pictures of people or things, are presented to a person who is asked to describe what he or she sees •Theory: people PROJECT their own personality and unconscious fears onto other people and things – in this case, the ambiguous stimuli – and, without realizing it, reveal their unconscious thoughts to the therapist oRorschach inkblot test: oComprehensive System: this system specifies how the cards should be presented, what the examiner should say, and how the responses should be recorded oThematic Appercation Test (TAT) – best known PT Consists of 31 cards: 30 picutres on them and one blank card, only only 20 cards are typically used – the instructor tells the person to tell a dramatic story about the picture Based on the notion that people will reveal their unconscious mental processes in their stories about the pictures Personality Inventories •NA – Minnesota Multiphasic Personality Inventory oBased on an empirical approach – collection and evaluation of data oThe individual being assessed reads statements such as “I cry easily” or “I believe I am being followed”, and answers either true or false oIndividual responses are not examined: instead, the pattern of responses is reviewed to see if it resembles patterns from groups of people who have specific disorders (e.g. a pattern similar to agroup with schozphrenia) o… Intelligence Testing •Intelligence tests were initially created to seek intelligence and predict who would do well in school – predict academic success •Binnet – develop a test that would identify “slow-learners” who would benefit from remedial help •Stanford Binet – provided a score known as an intelligence qutient or IQ •Updated to deviation IQ – a person’s score is compared only with scores of others of the same age •David Wechsler – versions for adults WAIS-III and one for children – all contain verbal scales (which measure vocabulary, knowledge of facts, short-term memory, and verbal reasoning skills) and performance scales (which assess psychomotor abilities, nonverbal reasoning, and ability to learn new relationships Neuropsychological Testing •Means assessment of brain and nervous system functioniong by testing an individual’s performance on behavioural tasks •Measures abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilites, and learning and abstraction in such a way that the clinician can make educated guesses about the person’s perofmran and possible existence of brain impairment oTesting assesses brain dysfunction by observing its effects on the person’s ability to perform certain tasks •Simple example: Bender Visual-Motor Gestalt Test – a child is given a series of cards on which are drawn various lines and shapes – task is for child to copy what is drawn on the card – errors on the test are compared with test results of oter children of the same age; if the number of errors ecveeds a certain amount, then brain dysfunction is suspected •Research on the validity suggests these tests may be useful for detecting organic damage and cognitive disorders •May be useful in predicting the development of certain cognitive disorders oEx. Can predict Alzheimer’s disease in people with delayed verbal recall •FALSE POSITIVES – assessment error in which pathology is reported (i.e. test results are positive) when non is actually present •FALSE NEGATIVES – assessment error in which pathology is reported (i.e. test results are negative) when it is actually present Neuroimaging: Pictures of the Brain •Recent years we have developed the ability to look inside the brain and take accurate pictures of its structure and function using technique – NEUROIMAGING – sophisticated computer-aided procedures that allow nonintrusive examination of nervous system structure and function •Can be divided into two categories oone category includes procedures that examine the STUCTURE of the briain, such as the various parts and whether they are damaged osecond category are producdures that examine the actual FUNCTIONING of the brain by mapping blood flow and other metabolic activity oImages of Brain Structure: First technique 1970s utilizes multiple X-ray exposures of the brain from different angles – that is X-rays are passed direcly through the head – a computer scan then reconstructs pictures of various slices of the brain – CAT scan Proven very useful Specifically useful in locating brain tumours, in juries, and other structural and anatomical abnormalties One difficulty – involved repeated radiations, which poses some risk of cell damage MRI – gives greater resolution than a CAT scan without the inherent risks of X-rays Patenrs head is placed in a high-strenght magnetic field through which radio frequency signals are transmitted – these signals “excite” the brain tissue, altering the protons in the hydrogen atoms – the alteration is measured, along with the time it takes the protons to “relax” or return to normal – where there are lesions , the signal is ligher or darker oImages of Brain Functioning Position emission tomography (PET) – subjects are injected with a tracer substance attached to radioactive isotopes – this substance interacts with blood, oxygen, or glucose – when parts of the brain become active, bloox, oxygen, or glucose rusehs to these area – thus we can learn what parts of the brain are working and what parts are not Recent PET scans are used increasingly to look at varying patterns of metabolism that might be associated with different disorders Recent scans have demonstrated that many patients with early Alzheimer’s0tyoe dementia show reduced glucose metabolism in the parietal lobe Second procedure used to assess brain functinoining is called single photon emission computed tomography (SPECT) – like first one but different substance is userd – less expensive – used more frequently Most exciting advances include involve MRI procedures that have been developed to work much more quickly than the regular MRI –
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