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Chapter 4

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University of Guelph
PSYC 3390
Mary Manson- Hennig

Chapter 4 CLINICAL ASSESSMENTFirst a clinician must identify the presenting problem or major symptoms or behaviours An adequate assessment includes much more than the diagnostic label For example it should include an objective description of the persons behaviourAssessment should include a description of any relevant longterm personality characteristicsIt is also important to assess the social context in which the individual operates The diverse and often conflicting bits of info about the individuals personality traits behaviour patterns environmental demands and so on must then be integrated into a consistent and meaningful picture Some clinicians refer to this picture as dynamic formulation because it not only describes the current situation but also includes hypotheses about what is driving the person to behave in maladaptive ways Test results are only released to third party if release form is signedWhen patients are given appropriate feedback on test resultsthey begin to improve just from gaining a perspective on their problems from the testing People who were provided with feedback showed significant decline in reported symtoms and an increase in measured selfesteem as a result of havinga clearer understanding of their own resourcesA physical examination consists of the kinds of procedures most of us have experienced in getting a medical check upBecause brain pathology is sometimes involved in some mental disorders a specialized neurological examination can be administered in addition to the general medical examination This may involve the clients getting an electroencephalogram EEG to assess brain wave patterns in awake and sleeping states An EEG is a graphical record of the brains electrical activity It is obtained by placing electrodes on the scalp and amplifying the minute brain wave impulses from various brain area these amplified impulses from various brain areas these amplified impulses drive oscillating pens whose deviations are traced on a strip of paper moving at a constant speed Significant divergences from the normal pattern can thus reflect abnormalities of brain function such as might be caused by a brain tumour or other lesions When an EEG reveals a dysrhythmia irregular pattern in the brains electrical activity other specialized techniques may be used in an attempt to arrive at a more precise diagnosis of the problem Anatomical Brain ScansRadiological technology such as computerized axial tomography CAT scan is one of the specialized techniques Through the use of xrays a CAT scan reveals images of parts of the brain that might be diseasedCAT scans have been increasingly replaced by magnetic resonance imaging MRI The images of the interior of the brain are frequently sharper with MRI because of its superior ability to differentiate subtle variations in soft tissue Pet Scans A Metabolic PortraitAnother scanning technique is positron emission tomographythe PET scan Although a CAT scan is limited to distinguished anatomical features such as the shape of a particular internal structure a PET scan allows for an appraisal of how an organ is functioning The PET scan providesmetabolic portraits by tracking natural compounds such as glucose as they are metabolized by the brain or other organs The Functional MRIThe technique known as functional MRI fMRI has been used in the study of psychopathology for more than a decade As original developed and employed the MRI could reveal brain structure but not brain activityThe fMRI however is an alternative to PET scans Simply put in its most common form fMRI measures changes in local oxygenation of specific areas of brain tissue that in turn depend on neuronal activity in those specific regions Ongoing psychological activity such as sensations images and thoughts can thus be mapped at
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