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Chapter 4

CH4 Textbook Notes


Department
Psychology
Course Code
PSY240H1
Professor
S.Cassin
Chapter
4

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CHAPTER 4 ASSESSING AND DIAGNOSING ABNORMALITY
- assessment is the process of gathering information about peoples symptoms and the possible
causes of those symptoms
- information gathered is used to determine the appropriate diagnosis, a label attached to a set
of symptoms that tend to occur with one another
Gathering Information
Symptoms and History
- current symptoms, ability to function in various domains of life
- the criteria for diagnosing most major psychological disorders require that the symptoms be
severe and pervasive enough that they are interfering with the persons ability to function in daily
life
- coping with symptoms, recent events
- history of psychological problems, family history of disorders
Physiological and Neurophysiological Factors
- when client seek an assessment of what appear to primarily be psychological symptoms, good
idea for clinician to have them obtain a complete physical examination to determine if they are
suffering from any medical conditions that can create psychological symptoms
- there are no definitive biological test for any psychological disorder
- drugs clients are taking
- many drugs can induce psychological symptoms as side effects
- protect against interactions between drugs and medications the clinician might prescribe
- assess cognitive functioning and intellectual abilities
- differential diagnosis: a determination of which of several possible disorders an individual may
be suffering
- e.g. paranoia can be result of paranoid personality disorder, schizophrenia, difficulties in
short-term memory
Sociocultural Factors
- social resources clients have available e.g. number of friends and family they have contact with
and the quality of those relationships
- sociocultural background
- e.g. for immigrants, culture raised in, circumstances that brought them to this country,
continuing connections to their homeland
- acculturation: the extent to which a person identifies with his/her group of origin and its culture
or with the dominant, mainstream culture
Assessment Tools
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Clinical Interviews
- initial interview, often called intake interview or mental status exam
- may be an unstructured interview with only a few open-ended questions
- clinician will listen to clients answers and observe how the client answers
- e.g. whether client hesitates, avoids questions, looks sad
- clinician may interview clients family members for info about familys history of psychological
problems, clients history and clients current symptoms
- especially important if client is a child or impaired
- unstructured interviews make comparisons of information gathered by different assessors
difficult
- structured interview: format is highly structured and standardized, clinician uses concrete
criteria to score the persons answers to each question
- Diagnostic Interview Schedule (DIS), Structured Clinical Interview for the DSM
- at the end of the interview, clinician should have enough information to determine
whether he/she has symptoms that qualify for a diagnosis of any major type of
psychological problems
- limitation: resistance from client who is being interviewed, client may have a strong
interest in the outcome of that assessment and thus be highly selective in the information
provided
Cognitive, Symptom, and Personality Tests
Validity
- accuracy of a test in assessing what it is supposed to measure
- best way to determine validity is to see if the results of the test yield the same information as
an objective and accurate indicator of what the test is suppose to measure
- a test is said to have face validity when, on face value, the items seem to be measuring what
the test is intended to measure
- content validity: the extent to which a test assesses all the important aspects of a phenomenon
that it purports to measure
- concurrent validity: the extent to which a test yields the same results as other measures of the
same behaviour, thoughts, or feelings
- a test that has predictive validity is good at predicting how a person will think, act or feel in the
future
- construct validity: the extent to which the test measures what its supposed to measure
Reliability
- an indicator of the consistency of a test in measuring what its supposed to measure
- test-retest reliability: an index of how consistent the results of a test are over time
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- typically, measures of general and enduring characteristics should have higher test-retest
reliability than measure of momentary, transient characteristics
- people taking the same test a second time may remember their answers from the first
time so researchers often develop two or more forms of a test
- alternate form reliability: when peoples answers are similar on the different tests
- researcher may split a test into two or more parts
- internal reliability: similarity in peoples answers among different parts of the same
test
- inter-rater or inter-judge reliability: different raters or judges who administer and score the
interview/test should come to similar conclusions when they evaluate the same people
Neuropsychological Test
- paper-and-pencil neuropsychological tests may be useful in detecting specific cognitive and
fine-motor deficits
- Bender-Gestalt Test: assesses clients sensorimotor skills by having them reproduce a set of
nine drawings
- seems good at differentiating people with brain damage from those without but unreliable
in identifying the specific type of brain damage
- advances in mapping the specialized functions of distinct brain regions help identify brain
damage
Brain-Imaging Techniques
- brain scans can determine brain injury or presence of a tumour
- blood tests can detect medical problems that might contribute to certain psychological
symptoms
- researchers use brain scans and blood tests to search for differences in biochemicals or brain
activity or structure between people with a psychological disorder and people without
- computerized tomography (CT): narrow x-ray beams are passed through the head in a single
plane from a variety of angles
- amount of radiation absorbed by each beam is measured and constructed into an image
of a slice of the brain
- by taking many slices, the computer can reconstruct a 3D image showing major
structures of the brain
- limitation: exposes patients to x-rays, provides only an image of brain structure rather
than brain activity
- positron-emission tomography (PET): patient injected with a harmless radioactive isotope,
fluorodeoxyglucose (FDG), which travels through the blood to the brain
- parts of the brain that are active need the glucose in FDG for nutrition so FDG
accumulates in the active parts of the brain
- subatomic particles in FDG, positrons, are emitted as the isotope decays
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