PSYCH 257 Chapter 3, 15: Test 1 Part 2
SchoolUniversity of Waterloo
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Chapter 3 Clinical Assessment and Diagnosis!
-The processes of clinical assessment, vital to psychopathology diagnosis and treatment.
Clinical assessment is the systematic evaluation and measurement of psychological,
biological, and social factors in an individual presenting with a possible psychological
disorder. Diagnosis is the process of determining whether the particular problem afﬂicting the
person meets all criteria for disorder, as set in the Diagnostic and Statistical Manual of Mental
Disorders, or DSM-5.!
-Example, Frank, shuts eyes frequently with leg twitching, has thoughts about seizure, marital
issues and issues at work, very tense, anxious at ﬁrst when talking to psychiatrist. Young man
experiencing substantial stress, thinks he is incapable of handling marriage and job etc.!
-Example 2, Brian, having thoughts of self-harm and harming other people, particularly
children, afraid he would snap and act on these thoughts!
-In both examples above, how would both individual’s problems be addressed by psychiatrist? !
-Assessing psychological disorders, the process is compared to a funnel, begin by collecting
large amounts of information across a broad range of the individual’s functioning to determine
source of problem. !
•Getting preliminary sense, start to narrow and focus by ruling out problems that are not
relevant, and concentrating on areas that are most relevant. !
•Clinicians use 3 basic concepts that determine the value of assessments; reliability, validity,
and standardization, assessment techniques are subject to a number of strict requirements !
•Not the least of which is some evidence, that they actually do what they are designed to do. !
•Another important requirement is that the measurement is reliability, degree of
consistency. When two or more raters state different conclusions, the diagnosis is not
reliable. Presenting the same symptoms to different physicians should result in the same
diagnoses, to improve reliability is to carefully design assessment devices and then
conducting research on them to ensure that two or more raters will get the same answers
(inter-rater reliability), and ensure the techniques are stable across time (test re-test
reliability). If the test presented on tuesday, if it is reused on friday, should get same result!
•Validity is whether something measures what it is designed to measure, in this case,
whether a technique assesses what it is supposed to, comparing the results of one test to
another one that’s measuring the same thing that is more well known allows you to begin to
determine the validity of the ﬁrst measure, this comparison is called concurrent or
descriptive validity. Example, IQ test results from standard and long version is same as
short version, can conclude that the brief version has concurrent validity. Predictive
validity is how well your assessment tells you what will happen in the future, for example,
IQ test determines if you will do well in school.!
•Standardization is the process by which a certain set of standards or norms is determined
for a technique to make its use consistent across different measurements. The standards
might apply to testing, scoring and evaluation. To see the standardization, give to a large
number of people who differ on important factors, and then their scores would be used as
the standard for comparisons. Compare score to people like you, not people unlike you!
-Clinical assessment procedures; acquire necessary information to assist patients, include
clinical interview, subdivided into -> mental status exam, physical examination, behavioural
observation and assessment, and psychological tests:!
•Clinical interview; interview used to gather information on current and past behaviour,
attitudes, and emotions + history of life in general, and of the problem. Determine when the
problem started, and other events that may have happened around the same time. Most
clinicians gather at least some information on patient’s interpersonal and social history,
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including family makeup, and individual’s upbringing. Sexual development, religious
attitudes, cultural concerns and educational history are also collected. To organize the
information, many clinicians use a mental status exam.!
•Mental status exam, involves systematic observation of somebody’s behaviour, clinicians
organize observations that allows them to determine whether a disorder is present, exams
performed quickly through the course of an interview or observation of patient, covers 5
-Appearance and behaviour, notes any overt physical behaviours such as posture,
clothes, general appearance and facial. (effortful motor behaviour is sometimes referred
to psychomotor retardation -> depression)!
-Thought processes; clinicians listen to patient talk, getting idea of person’s thought
processes, look for things like how fast they talk, do they make sense, organization of
thoughts and ideas, schizophrenia is associated with disjointed speech pattern and
looseness of association and their ideas have no connection. Clinicians also pay close
attention to the content of their speech, is there evidence of delusions, delusions of
persecution, someone thinks people are after them, out to get them all the time,
individual might also have ideas of reference, where everything everyone else dose
relates back to them. Hallucinations, when people sees or hears things that are not there!
-Mood and affect; predominant feeling state of the individual, depressed or hopeless,
anxiety etc. Affect, is the feeling state that accompanies what we say at a given time -> if
someone tells you they’ve won the lottery and crying, it would be seen as strange!
-Intellectual functioning, clinicians make estimate of intellectual functioning by analyzing
words they use, can they talk in abstractions and metaphors, memory, can conclude if
person is above or below average!
-Sensorium, general awareness of surroundings, does the individual know what the date
is, time, where they are, who they are etc., people with brain damage or dysfunction,
may not know the answer to these questions even if damage is temporary. !
-Conclusions; allows clinicians to make preliminary determination of which areas of the
patient’s behaviour and condition should be assessed in more detail. If disorders remain
possibility, the clinician may then hypothesize which disorders ﬁt present symptoms. This
process, provides more focus for the assessment and diagnostic activities to come!
-Information gained about the patient is protected by laws of privileged communication or
conﬁdentiality, cannot have access unless patient expresses consent, unless harm or
danger to either the patient or someone else is imminent!
•Semistructured clinical interviews; different patients seeing different psychologists or other
mental health professionals might encounter markedly different types and styles of
interviews. Unstructured interviews follow no systematic format, semistructured interviews
are 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. However, may depart from set questions to
follow up issues. Having wording and sequence that have been worked out over years,
clinicians can feel conﬁdent that semistructured interview will accomplish purpose,
however, disadvantage is that the interview may not have spontaneous quality of two
people talking about issues, applied too rigidly, this interview can cause patient from
volunteering useful information when it is not directly relevant to the questions being asked.
For these reasons, fully structured interviews administered wholly by a computer have not
caught on. Anxiety Disorders Interview Schedule DSM-5 contains structured interviews for
disorders like OCD and other anxiety disorders. Also available is the Structured Clinical
Interview for DSM-5, used to assess variety of disorders. Clinicians will ask if patient
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bothered by certain thoughts, images, impulses or compulsions, rate on 8 points scale from
never to constantly, then rate obsession based on persistence and distress and resistance
to thoughts. For compulsions, patient provides rating of frequency.!
-Physical examinations, if patient has disorder and not had physical exam in the past year,
clinician might recommend one, with attention to conditions associated with mental disorders.
Many mental disorders associated to a temporary toxic state caused by bad food, wrong
medicine, or medical condition like thyroid difﬁculties, may produce symptoms that mimic
anxiety disorders. Hyperthyroid or hypothyroidism may both produce different symptoms
similar to anxiety and depression respectively. Delusions or hallucinations associated with
brain tumour, withdrawal from cocaine causes panic attacks etc. Clinicians are aware of
medical conditions and drug use that may contribute to kinds of problems described by
patients. To discover causation, must look at time of onset for the disorder and then time for
the suspected cause. (Depression started 5 years ago, but hypothyroidism started 2 years
ago, conclude hypothyroidism is not the cause)!
-Behavioural assessment, assess how people think, feel and behave and how these actions
contribute to problems, behavioural assessment uses direct assessment for an individual’s
thoughts, feelings and behaviour in speciﬁc situations or contexts; this information should
explain why he or she is having difﬁculties. Behavioural assessment much more appropriate
than an interview in terms of assessing individuals who are not old enough or skilled enough
to report their problems and experiences. Clinical interviews sometimes provide limited
assessment information. Young children or individuals who are not verbal because of the
nature of their disorders/due to cognitive deﬁcits and people who with hold information are not
ﬁt for clinical interviews. May go to person’s home, set up situations and observe individuals
to see how they behave in natural setting, all apart of behavioural assessment.!
•In BA, target behaviours are identiﬁed and observed with the goal of determining the
factors that cause said behaviours. It is difﬁcult to discover what is bother a particular
-For example, 7 year old with conduct disorder, mother and teacher of the child had
different views of the child. Mother said son was just misbehaved while the teacher said
the child made very serious threats. Clinicians then went into the home of the child to
observe him in a real life setting, mother asks him to put away glass, he throws across
room. Mother’s description didn’t give a good picture of child’s problems. The treatment,
if given based on the mother’s description, would be radically different from the one that
•Clinicians, assume that complete picture of person’s problems requires direct observation
of person’s problems in real setting. This is not always feasible, thus, clinicians create
-Example, children with autism, reasons for self-injurious behaviour discovered by placing
children in simulated situations such as sitting alone at home etc. Observing how
children behave in setting, determine the reason and thus design a successful treatment.
David Wolfe, uses such situations to assess the emotional reactions of parents with
history of abuse to children. By asking parents to have their children put away favourite
toys, the child will usually cause trouble, leading to the reaction of the parent, allowing
clinicians to observe and analyze!
•ABC’s of observation, clinician’s focus on immediate behaviour, its antecedents, and its
consequences. Example of the disobedient young boy, mother asking him to put glass
away (antecedent), the boy throwing the glass (behaviour), and his mother’s lack of
response (consequence) This ABC sequence might suggest that he boy was reinforced for
his violence, w/o consequence of his behaviour, he will probably act violently!
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