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PSY100H1 (1,831)
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Chapter 4

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Chapter 4 • Assessment: process of gathering information about people’s symptoms and the possible causes of those symptoms; used to determine diagnosis • Diagnosis: label attached to a set of symptoms that tend to occur with one another Gathering information • Symptoms and history o Current symptoms (severity and chronicity) o Ability to function o Coping with stress o Recent events (response to specific event versus no trigger) o History of psychological problems o Family history of disorders • Physiological and neurological factors o Physical examination (medical conditions that create psychological symptoms) o Drugs o Cognitive functioning and intellectual abilities • Differential diagnosis: determination of which of several possible disorders an individual may be suffering • Sociocultural factors o Social resources (quality of relationships with friends/family) o Sociocultural background o Acculturation: extend to which a person identifies with his group of origin and its culture or with the dominant, mainstream culture; consider whether patient is experiencing psychological distress in somatic symptoms (common in some cultures) or will respond to clinician’s suggestions Assessment tools • Clinical interviews • Intake interview: also called mental status exam; initial interview where clinician first meets the client • Unstructured interview: only a few questions that are open-ended; observe how client answers (non-verbal indicators); can also interview client’s family members for information about history of psychological problems, client history and client’s current symptoms; specific questions vary from one clinician to the next • Structured interview: respondent asked a series of questions about symptoms experienced; format of questions and entire interview highly structured/standardized and clinician uses concrete criteria to score each answer; examples are Diagnostic Interview Schedule and Structured Clinical Interview for the DSM • Resistance: limitation to interviews; people do not want to be assessed or treated; selectivity or bias in presentation of behaviour • Cognitive, symptom and personality tests • Validity: accuracy of a test in assessing what it is supposed to measure; see if results of test yield the same information as an objective/accurate indicator of what the test is supposed to measure o Face validity: test appears to measure what it is supposed to measure o Content validity: test assesses all important aspects of a phenomenon o Concurrent validity: test yields same results as other measures of the same behaviour, thoughts or feelings o Predictive validity: test predicts the behaviour it is supposed to measure o Construct validity: test measures what it is supposed to measure, not something else • Reliability: indicator of the consistency of a test in measuring what it is supposed to measure o Test-retest reliability: test produces similar results when given a two points in time o Alternate form reliability: two versions of the same test produce similar results o Internal reliability: different parts of the same test produce similar results o Inter-rate reliability: two or more raters or judges who administer and score a test come to similar conclusions • Neuropsychological tests: paper and pencil; useful in detecting specific cognitive and fine-motor deficits (ex: attentional problem); used if neurological impairment is suspected • Bender-Gestalt Test: assesses clients’ sensorimotor skills by having them reproduce a set of nine drawings; can differentiate those with brain damage from those without • Mapping functions of brain regions: some functions/skills associated with particular brain regions; discover where skills relevant to tasks are located in which brain regions; ex: Halstead-Reitan test and Luria Nebraska test • Brain-imaging techniques: used to identify specific deficits and possible brain abnormalities; brain scans (brain injury/tumour), blood tests (medical problems); look for differences between people with disorder and people without • Computerized tomography (CT): enhancement of X-ray procedures; can reveal brain injury, tumours and structural abnormalities, limitations are it exposes patients to potentially harmful x-rays and provides only image of brain’s structure, not brain’s activity 1. Narrow x-ray beams are passed through a person’s head in a single plane from a variety of angles 2. Amount of radiation absorbed by each beam is measured 3. From these measurements, a computer program constructs an image that looks like a slice of the brain 4. By taking many slices of the brain, the computer can construct a 3- dimensional image, showing brain’s major structures • Positron-emission tomography (PET): provide a picture of activity in brain; can be used to show differences of activity level of specific areas of brain between people with/without psychological disorder; ex: serotonin is abnormally regulated during major depressive episodes 1. Patient injected with harmless radioactive isotope, like fluorodeoxyglucose (FDG) 2. It travels through blood to the brain, where it is accumulated in the active parts, which need FDG’s glucose for nutrition 3. Positrons are emitted as the isotope decays, which collide with electrons, annihilating both and converting them to photons, which travel away from each other in opposite directions 4. PET scanner detects these photons at the annihilation point and constructs an image of the brain, showing areas that are most active • Magnetic resonance imaging (MRI): provide pictures of activity and functioning in the brain; creates a magnetic field around brain that is so powerful it causes a realignment of brain’s hydrogen atoms; when field is turned on and off, hydrogen atoms change position and so emit magnetic signals, which are read by a computer to reconstruct 3-D image of the brain o Advantages: does not require exposing patient to any form of radiation or radioisotope injection; safe to use repeatedly in the same patient; finely detailed pictures of anatomy of brain; can image brain at any angle • Intelligence tests: used to get a sense of a client’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected; also to identify children with intellectual difficulties or who are “gifted”; used in occupational settings/military to determine capability; examples are the Stanford- Binet Intelligence test and Wechsler Adult Intelligence Scale; designed to measure basic intellectual abilities (abstract reasoning, verbal fluency and spatial memory) • Intelligence quotient: term used to describe a method of comparing an individual’s score on an intelligence test with the performance of individuals of the same age group • Controversy: what is meant by intelligence; do not assess non-verbal or non- analytical skills; success strongly influenced by social skills and other talents; bias in favour of educated upper-middle class European North Americans • Symptom questionnaire: clinician asks patient to complete this; quick way to assess what symptoms a person is experiencing; wide variety or specific; ex: Beck Depression Inventory; select which descriptions best fits your feelings o Advantages: quick and easy to administer; good test-retest reliability; monitoring tool of symptoms o Disadvantages: does not clearly differentiate between clinical syndrome of depression and general distress related to anxiety disorder or other disorder; cannot indicate whether respondent would qualify for diagnosis • Personality inventories: questionnaires meant to assess people’s typical ways of thinking, feeling and behaving; used as part of an assessment procedure to obtain information on people’s well-being, self-concept, ways of coping, etc; • Minnesota Multiphasic Personality Inventory (MMPI): most widely used inventory; developed empirically (items that were reliably differentiated between healthy and psychological problem plagued people included); variety of scales (answers are matched against that of normal population: four validity scales o Advantages: can catch individuals faking participants (in some cases); high test-retest reliability; useful as general screening device for detecting people who are psychologically poorly functioning o Disadvantages: not culturally diverse or representative; linguistic accuracy of translated versions • Projective tests: based on the assumption that when people are presented with an ambiguous stimulus (oddly shaped inkblot), they will interpret the stimulus in line with their current concerns and feelings, relationships or desires; project issues as describe content; can be useful as uncover unconscious motives/thoughts; ex: Rorschach Inkblot Test, Sentence Completion Test, Thematic Apperception Test; very subjective and do not include cultural differences; not strong reliability or validity • Behavioural observation: assess deficits in client’s skills or ways of handling situations; observe interaction to suggest solutions; does not rely on client’s reporting and interpretation of behaviour but is subjective and time-consuming • Self-monitoring: client keeps track of number of times a day in which they engage in certain behaviour and the conditions under which it happens; biases; insight into triggers • Problems in assessment • Evaluating children: not always well-developed understanding of causes of behaviour/emotions; hard to verbalize feelings; parents’ perceptions biased by their own symptoms or expectations; parents can be the problem; cultural norms differ; discrepancies between teachers, counsellors and parents • Cultural differences: language barriers can lead to under or over diagnosis; untrained interpreters; might not consider differing cultural beliefs; differences in presentation of symptoms; fears of stigmatization; psychological distress experienced and reported in terms of emotional or somatic symptoms; training in diversity and culture-specific services part of the solution Diagnosis • Syndrome: set of symptoms; observable manifestation of underlying disorder; lists of symptoms that tend to co-occur within individuals
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