Chapter 4 10/23/2012 8:44:00 AM
The Basic Elements in Assessment
- The presenting problem is the major symptoms and behaviour
- A formal diagnosis is necessary for some kinds of health coverage
- An adequate assessment should include an objective description of the
persons behaviour, long-term personality characteristics, social context
that the individual operates in
Assessement of the Physical Organism
- Medical examination may include a general physical exam and special
examinations aimed at assessing the structural (anatomical) and
functional (physiological) integrity of the brain as a behaviourally
significant physical system
- A physical exam consists of the kinds of procedures most of us have
experienced in getting a medical checkup—a medical history is obtained
and major systems of the body are checked
- A client may get an electroencephalogram (EEG) to assess brain wave
patterns in awake and sleeping states—graphical record of the brains
electrical activity. You place electrodes on the scalp and amplify the
minute brain wave impulses from various areas which inturn drive
oscillating pens whose deviations are traced on a strip of paper moving at
a constant speed
- When an EEG reveals a dysrhythmia (irregular pattern) in the brains
electrical activity, other techniques may be used in an attempt to arrive
at a more precise diagnosis of the problem
- Radiological technology like computerized axial tomography (CAT) scans
is another specialized technique—they reveal images of parts of the brain
that might be diseased
- CAT scans have been increasingly replaced by magnetic resonance
imaging (MRI), these images of the interior of the brain are frequently
sharper with MRI because of its superior ability to differentiate subtle
variations in soft tissue—MRI involves the precise measurement of
variations in magnetic fields that are caused by the varying amounts of
water content of organs and parts of organisms—MRI studies have
considerable potential to illuminate the contribution of brain anomalies to
nonorganic psychoses like schizophrenia - PET scan allows an appraisal of how an organ is functioning—this provides
a metabolic portrait by tracking natural compounds like glucose, as they
are metabolized by the brain or other organs
- The use of PET scans in research on abnormal functioning on brain
pathology, like schizophrenia, depression and alcoholism may lead to
important discoveries about the organic processes underlying these
disorders, therefore providing clues to more effective treatment—
unfortunately, PET scans have been of limited value thus far because of
the low-fidelity pictures obtained
- The functional MRI (fMRI) can reveal brain structure but not brain
activity—fMRI measures changes in local oxygenation of specific areas of
brain tissue that in turn depend on neuronal activity in those specific
areas—thought to hold more promise for depicting brain abnormalities
than currently used procedures, like neuropsychological examinations
- Studies have shown that impaired time estimation found in
schizophrenics might result from dysfunction in specific areas of the
brain, thalamus and prefrontal cortex and auditory hallucinations in
schizophrenia might relate to cortical functioning
- fMRI and MRIs are sensitive to artifacts created by slight movements of
the person being evaluated—also, the results of the studies are
sometimes very difficult to interpret
- there is a growing cadre of psychologists specializing in
neuropsychological assessment—which involves the use of various testing
devices to measure a persons cognitive, perceptual and motor
performance as clues to the extent and location of brain damage
- standardized tasks that involve perceptual-motor and other tasks can
provide clues to the probable location of the brain damage, even though
PET scans, MRIs and other physical tests may be more effective in
determining the exact location
Psychosocial Assessment
- analogue situations are designed to yield information about the persons
adaptive strategies, involving role-playing, even re-enactment, family
interaction assignments or think-aloud procedures
- clinicians instruct clients in self-monitering—self observation an objective
reporting of behaviour, thoughts and feelings as they occur in various
natural settings - the use of rating scales in clinical observation and in self-reports helps
both to organize information and to encourage reliability and objectivity
- one of the rating scales most widely used for recording observations in
clinical practice and in psychiatric research is the Brief Psychiatric Rating
Scale (BPRS)—this provides a structured and quantifiable format for
rating clinical symptoms like somatic concern, anxiety, emotional
withdrawal, guilt feelings, hostility, suspiciousness and unusual thought
patterns
- psychological tests measure coping patterns, role behaviours, motive
patterns, personality characteristics, values, levels of depression or
anxiety and intellectual functioning
- a clinician can choose from a wide variety of intelligence tests—the
Wechsler intelligence scale for children revised and the current edition of
the Stanford-binet intelligence scale are widely used in clinical settings for
measuring intellectual abilities of children
- adult scale involves comprehension, perceptual reasoning, working
memory and processing speed with 15 subtests: the vocabulary subtest
consists of a list of words to define, presented orally to the individual,
designed to evaluate knowledge of vocabulary, which has been shown to
be highly related to general intelligence and the digit span subtest tests
short term memory
- personality tests are either projective or objective—projective tests are
unstructured and rely on various ambiguous stimuli, like inkblots and
vague pictures, rather than on explicit verbal questions, and in that the
persons responses are not limited to the true, false, or cannot say
variety—the idea is that people reveal a good deal about their personal
preoccupations, conflicts, motives, coping techniques and other
personalities through their projective interpretation of the stimuli
- the Rorschach test is named after the Swiss psychiatrist who intitiated the
experimental use of inkblots in personality assessment in 1911—results
can be unreliable because of the subjective nature of test interpretations,
however, certain psychodynamic issues, like the impact of unconscious
motivations on current perceptions of others, can be results of the test
- a thematic apperception test (TAT) was introduced in 1935 and is still
used in clinical practice and personality research—the TAT uses a series of simple pictures, some highly representatio
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