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Chapter 4

PSY240 - Chapter 4 (part 1)

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University of Toronto Mississauga
Ayesha Khan

CHAPTER 4: CLINICAL ASSESSMENT • psychological assessment o procedure by which clinicians. using psychological tests, observations and interviews, develop a summary of the client’s symptoms and probs • clinical diagnosis o process through which a clinician arrives at a general “summary classification”of the patient’s symptoms by following a clearly defined system such as DSM-IV-TR or ICD-10 (International Classification of Diseases), published by the World Health Organization • assessment is an ongoing process and may be imp at other points in treatment THE BASIC ELEMENTS IN ASSESSMENT • first, clinician must identify the presenting problem, or major symptoms and behaviour The Relationship between Assessment and Diagnosis • imp to have an adequate classification of the presenting problem and also a diagnostic categorization if possible for many reasons o formal diagnosis necessary for some health insurance coverage o can help in planning and managing appropriate treatment o to determine which treatment facilities need to be available Taking a Social or Behaviour History Social Context • what kind of environmental demands are typically placed on the person • what supports/special stressors exist in that person’s life • diverse and often conflicting bits of info about the individual’s personality traits, behaviour patterns, environmental demands and so on must be integrated into a consistent and meaningful pic o some clinicians refer to it 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 The Influence of Professional Orientation • biologically oriented clinician o likely to focus on biological assessment methods aimed at determining any underlying organic malfunctioning that may be causing the maladaptive behaviour • psychodynamic/psychoanalyst o may choose unstructured personality assessment techniques to identify intrapsychic conflicts or simply proceed with therapy, expecting these conflicts to emerge as part of the treatment process • behavioural o to determine functional relationships between environmental events or reinforcements and the abnormal behaviour; will rely on techniques like behavioural observation and self-monitoring • cognitively oriented behaviourist o focus would shift to dysfunctional thoughts • humanistic o may use interview techniques to uncover blocked/distorted personal growth • interpersonal o may use personal confrontations and behavioural observations to pinpoint difficulties in interpersonal relationships • Note: does not imply that clinicians of a particular orientation limit themselves to a particular assessment method or a particular theoretical orientation o merely shows that they place emphasis on some types of assessment Trust and Rapport between the Clinician and the Client • in a clinical assessment the client must o feel that the testing will help the practitioner gain a clear understanding of his/her probs o must understand how the tests will be used and how the psychologist will incorporate them into the clinical evaluation o clinician should explain what will happen during assessment and how the info gathered will help provide a clearer pic of the client’s probs • clients need to be assured that o feelings, beliefs, attitudes and personal history that they are disclosing will be used appropriately, kept in strict confidence and made available only to therapists or others involved in the crde o test results are generally released to 3 party (ex. court) only if the client signs an appropriate release form  in the case that the client is being tested for a 3 party, it is the referring source, not the client  likely to be less motivated to be tested in this situation • in a clinical setting, clients are usually highly motivated to be evaluated and like to the know the results of the testing o clinicians more likely to provide test feedback, which is imp for treatment  when ppl who were not provided psychological test feedback were compared with those who were, the latter group showed a significant decline in reported symptoms and an increase in measured self-esteem as a result of having a clearer understanding of their own resources ASSESSMENT OF THE PHYSICAL ORGANISM The General Physical Examination • basically a “medical checkup” o typically a medical history is obtained o major system of body are checked • important for disorders that entail physical probs such as somatoform, addictive and organic brain syndromes • a variety of organic conditions including hormonal irregularities can produce behavioural symptoms that closely mimic those of mental disorders usually considered to have psychosocial origins • some long-lasting pain can be related to actual organic conditions, but others can result from strictly emotional factors o ex. chronic back pain – psychological factors may play an imp part The Neurological Examination • EEG o used to assess brain wave patterns in awake and sleeping states o adult males with ADHD show abnormal brain activity Anatomical Brain Scans • CAT • MRI o measures variations in magnetic fields that are caused by varying amounts of water content of organs and parts of organs o particularly useful in confirming degenerative brain processes  good to illuminate contribution of brain anomalies in “nonorganic” psychoses such as Schizophrenia o ADV o images are sharper because of its ability to differential subtle variations in soft tissue o normally easier to administer o does not subject patient to ionizing radiation o DISADV o some patients are claustrophobic b/c placed into a narrow cylinder PET Scans: A Metabolic Portrait • PET o allows one to determine how an organ is functioning o useful to obtain clear-cut diagnoses of brain pathology  can reveal probs that are are not immediately apparent anatomically  may help discovery of organic processes underlying abnormal conditions o DISADV – low fidelity pics obtained o expensive The Functional MRI • studies using it have found o psychological factors or environmental events can affect brain processes o participants who were excluded from social participation showed a similar pattern of brain activation (in the right ventral prefrontal cortex) to that of participants experiencing physical pain o impaired time estimation found in schizophrenics might result from dysfunction in specific areas of the brain, thalamus and prefrontal cortex o auditory hallucinations in schizophrenia might relate to cortical functioning o effects of neuroleptic medication on schizophrenics o neuroanatomy of depression o can potentially help our understanding of early development of psychological disorders • Limitations o sensitive to artifacts created by slight movements of the person being evaluated o results often difficult to interpret o does not provide much specific info about processes studied o  not considered a valid/useful diagnostic tool for mental disorders; primary value continues to be research into cortical activity and cognitive processes The Neuropsychological Examination • behavioural and psychological impairments due to organic brain abnormalities may manifest before any organic brain lesion is detectable; therefore the following is imp: • neuropsychological assessment • involves use of various testing devices to measure a person’s cognitive, perceptual, and motor performance as clues to the extent and location of brain damage • many neuropsychologists prefer to administer a highly individualized array of tests depending on case history and other info • others administer a standard set of tests that hav
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