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Lecture 3

Week 3- Chapter 3- Assessment and Diagnosis.docx

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Psychology 2030A/B
David Vollick

Chapter 3- Assessment and Diagnosis ClinicalAssessment -Gathering information about a person and his/her environment to make decisions about the nature, status, and treatment of psychological problems -->treatments different depending on situation -->more information the better ->-from family, friends, schools -->the better the assessment going to be -begins with a set of referral question that determine goals of assessment -->determine goals or assessment -selection of appropriate psychological tests and measurements -->choose the ones that answers the referral questions (tests and measurements) -->when did it start, how often, consent Goals of Assessment Differential diagnosis is a process in which a clinician weighs how likely it is that a person has a diagnosis instead of another -What assessment procedures and instruments to administer -tailoring an assessment to types of symptoms, age, and medical status -->up to a certain age but after it become pathological -->what to take into account from the referral -screening (identify psychological problems or predict the risk for future problems) -->what is the risk of redeveloping -diagnosis (identification of illness) -->come up with a conclusion (from our knowledge) -treatments plan (individual's plan of care to meet mental health needs) -->antidepressants, psychological therapy (in referral question) -outcome evaluation -->what do I think that this patient will be like n time from now How to Find a Good Screening Tool Figure 3.1 Evaluating a Screening Tool for Depression (in textbook) Cases of Misdiagnosis -Deafness vs. Intellectual Disability -->patient must understand what you are asking before giving the test -Epilepsy vs. Schizophrenia -->mimic the symptoms of schizophrenia -Medication Reaction vs. Depression -->what kind of medication are they on -->Prozac- in adolescent can make them depression and suicidal -Brain tumor vs. Anorexia Nervosa -->brain tumor can cause a lot of symptoms (mMRI) -Impact of clinical significance -->not just statistical -->what does it mean clinically -->is the person really depressed, how significant is it And the Usual Properties ofAssessment Instruments Are… -Standardization -->all done the same way, all say the same thing, and act the same way -->when scoring it, it's done the same way -->reliability -->that the patient is getting cues from me and also from you -->everything is standardized -Normative comparison -->you get and I get -->take your age group and see how you fit in with the people your age -->ex. intelligence (IQ) -Self-referent comparisons -->see the results of the test prior to performance -->helps to trace the severity of the symptoms overtime -->compare scores of the past -Reliability -->comparison overtime -->test retest reliability.. Results are the time even if you do it many times -test-retest reliability -interrater agreement -all come up with the same agreement/ conclusion -Validity -construct (measure what it's supposed to do- come up with the same conclusion), criterion (how well does it correlate with something- iq and success), concurrent (same variable at the same time), predictive -->is it measuring what you want it to measure Assessing Abnormality Using the Normal Curve Figure 3.2 The Normal Curve -normal IQ 100 Developmental and Cultural Considerations -Age -People involved in testing- age, developmental status -->elderly with Dementia (not sure what is going on) -Nature of test chosen -"Culturally Fair" -->understand/ language well -->things with no cultural aspects -->ex. how many senate groups are there in the U.S Assessment Instruments -Self-report measures (ask patients to evaluate their own symptoms) -->ask questions from family, friends -->may not be quite real -Clinician-rated measures (clinician rates symptoms) Clinical Interviews -Conversation between an interviewer and a patient to gather information and make judgment related to assessment goals -->questions to help you in the assessment -->what they feel life, what happen to them, how well are they coping -Purpose: screening, diagnosis, treatment planning, or outcome evaluation -->look and determine what this patient is suffering from -Types of interviews -Unstructured- conclusions unreliable -->because there is no structure to it -Structured -->questionA, B, C (like a diagram) -->reliable -Open-/ Closed-ended questions -closed (yes/no) -open (can elaborate) Psychological Tests -->Objective Tests -Objective Personality tests -->tests that questions are sensible, long, and understandable -->ex. you like fishing? (yes/no) -Minnesota Multiphasic Personality Inventory (MMPI)-empirical keying (data of study) = discriminates -->helps distinguish between groups of people -->good for diagnosis -Nine clinical subscales + faking good & bad, lie scales -The Million Clinical Multiaxial Inventory (MCMI) -->does not fit well with the DSM -lacks fit with the DSM system and categories -personality disorders (3 pathological disorder) Figure 3.3 Simple MMPI Profile (in the textbook) Projective Tests -From psychoanalytic theory- respond to ambiguous stimuli -ThematicApperception Test (TAT; 1935) -Consist of 31 black-and-white pictorial cards and the patient is asked to make up a story about the image -Rorschach Inkblot Test -Shown ambiguous stimuli and then projects a unique interpretation onto them that reflects his/ her underlying unconscious processes and conflicts -Poor normative data- break the ice initially -->not a lot of people have been tested -->poor validity -->Exner (scoring system) -->standardized administration and
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