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Chapter 4

PSY240H5 Chapter Notes - Chapter 4: Wechsler Adult Intelligence Scale, Neuropsychological Assessment, Ct Scan


Department
Psychology
Course Code
PSY240H5
Professor
Ayesha Khan
Chapter
4

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PSY240 CHAPTER 4 CLINICAL ASSESSMENT
Psychological assessment procedure by which clinicians, using psychological tests, observation, and
interviews, develop a summary of the client’s symptoms and problems
Clinical diagnosis process through which a clinician arrives at a general “summary classification” of the
patient’s symptoms by following a clearly defined system *DSM-IV-TR or ICD-10]
Assessment ongoing process and may be important at other points during treatment
- Establishing baselines for various psychological functions so that the effects can of treatment
can be measured
- Criteria based on these measurements may be established as part of treatment plan such that
therapy is considered successful and terminated only when client’s behaviour meets
predetermined criteria
- Comparison of post-treatment with pretreatment assessment results essential feature of
many research projects designed to evaluate the effectiveness of various therapies
THE BASIC ELEMENTS IN ASSESSMENT
What does a clinician need to know?
- Must be able to identify the presenting problem, or major symptoms and behaviour
Taking a Social or Behavioural History
- Clear understanding of individual’s behavioural history, intellectual functioning, personality
characteristics, and environmental pressures and resources
- Excesses, deficits, and appropriateness key dimensions to note to understand particular
disorder
Personality Factors
- Assessment should include any relevant long-term personality characteristics
The Social Context
- What kinds of environmental demands are placed on the person, and what supports or special
stressors exist in their life situation
- The information about individual’s personality traits, behaviour patterns, environmental
demands must be integrated into a consistent and meaningful picture, referred to as “dynamic
formulation only describes current situation but also includes hypotheses about what is
driving the person to behave in maladaptive ways, formulation can allow clinician to develop
hypotheses about client’s future behaviour
- Which qualities does the patient bring to treatment that can enhance the chances of
improvement
- Assessment may involve coordinated use of physical, psychological, and environmental
assessment procedures because wide range of factors can play important roles in causing and
maintaining maladaptive behaviour
The Influence of Professional Orientation
- How clinicians go about assessment process depends on their basic treatment orientations
- Certain types of assessments are more conductive than others to uncovering particular causal
factors or for eliciting information about symptomatic behaviour central to understanding and
treating a disorder within a given conceptual framework
Trust and Rapport between the Clinician and the Client
- Client being evaluated must feel comfortable with clinician

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PSY240 CHAPTER 4 CLINICAL ASSESSMENT
- Clinician should explain what will happen during assessment and how information gathered will
help provide a clearer picture of problems client is dealing with
- Clients need to be assured that feelings, beliefs, attitudes, and personal history that they are
disclosing will be used appropriately, will be kept in strict confidence, and made available to only
therapists or others involved in the case
- * test results generally released to third party only if client signs an appropriate release form
- Providing test feedback in clinical setting can be important element in treatment process
- Clients tend to improve when given appropriate feedback on test results
- Persons who were not provided psychological test feedback compared with those who were
provided with feedback, latter group showed significant decline in reported symptoms and
increase in measured self-esteem as result of having clear understanding of their own resources
ASSESSMENT OF PHYSICAL ORGANISM
Medical evaluation may include both a general physical examination and special examinations aimed at
assessing structural (anatomical) and functional (physiological) integrity of brain as behaviourally
significant physical system
The General Physical Examination
- Medical history is obtained, and major systems of the body are checked
- Most clinicians insist on medical clearance before initiating psychosocially based interventions
The Neurological Examination
- Electroencephalogram [EEG] assess brain wave patterns in awake and sleeping states
o Graphical record of the brain’s electrical activity
o Obtained by placing electrodes on scalp and amplifying the minute brain wave impulses
from various brain areas; these amplified impulses drive oscillating pens whose
deviations are traced on strip of paper moving at constant speed
o Significant divergences from normal pattern can reflect abnormalities of brain function
o When EEG reveals dysrhythmia [irregular pattern+in brain’s electrical activity, other
specialized techniques may be used in attempt to arrive at more precise diagnosis of
problem
Anatomical Brain Scans
- Computerized axial tomography [CAT] specialized technique, through use of X-rays, reveals
images of parts of the brain that might be diseased
o Involves use of computer analysis applied to X-ray beams across sections of patient’s
brain to produce images that neurologist can interpret
o Limited to distinguishing anatomical features such as shape of a particular internal
structure
o Have been replaced by MRI
- Magnetic resonance imaging [MRI] images of interior of brain sharper because it has the
ability to differentiate subtle variations in soft tissue, less complicated to administer, does not
subject patient to ionizing radiation
o Involves precise measurement of variations in magnetic fields that are caused by varying
amounts of water content of organs and parts of organs
o Visualization of all but most minute abnormalities of brain structure
o Useful in confirming degenerative brain processes
o Considerable potential to illuminate contribution of brain anomalies to “nonorganic”
psychoses like schizophrenia

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PSY240 CHAPTER 4 CLINICAL ASSESSMENT
o Problem: some patients have claustrophobic reaction to being placed into narrow
cylinder of MRI machine that is required to contain magnetic field and block out
external radio signals
Pet Scans: A Metabolic Portrait
- Positron Emission Tomography [PET] allows for an appraisal of how an organ is functioning
o Provides metabolic portraits by tracking natural compounds, like glucose, as they are
metabolized by brain or other organs
o Enables medical specialist to obtain more clear-cut diagnoses of brain pathology
o May be able to reveal problems that are not immediately apparent anatomically
o Have been of limited value because of low-fidelity pictures obtained
The Functional MRI
- Functional MRI [fMRI] used in study of psychopathology
o Alternative to PET scans
o Measures changes in local oxygenation (i.e. blood flow) of specific areas of brain tissue
that depend on neuronal activity in those specific regions
o Psychological activity (sensations, images, and thoughts) can be “mapped” revealing
specific areas of the brain that appear to be involved in their neuropsychological
mediation
o Critically time-dependent
o Requires development of high-speed devices for enhancing recording process and
computerized analysis of incoming data
o fMRI technique has the potential of adding to our understanding of early development
of psychological disorder
o illustrated effects of neuroleptic medication on schizophrenics and neuroanatomy of
depression
o sensitive to artifacts created by slight movements of person being evaluated
o results of fMRI difficult to interpret, results do not provide specific information about
processes studied
The Neuropsychological Examination
- neuropsychological assessment involves use of various testing devices to measure person’s
cognitive, perceptual, and motor performance as clues to the extent and location of brain
damage
- in instances of known or suspected organic brain involvement clinical neuropsychologist
administers a test battery to patient
- person’s performance on standardized tasks can give valuable clues about any cognitive and
intellectual impairment following brain damage
- testing can provide clues of probable location of brain damage
- neuropsychologists prefer administer highly individualized array of tests, depending on a
patient’s case history and other available information
- other neuropsychologists administer standard set of tests that have preselected to sample, in
systematic and comprehensive manner
- cases where psychological difficulty thought to result from nonorganic causes, psychological
assessment is used
4.1 Neuropsychological Examinations: Determine Brain-Behaviour Relationships
Halstead-Reitan battery neuropsychological examination composed of several tests and
variables from which an “index of impairment” can be computed
Provides specific information about subject’s functioning in several skills areas
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