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Chapter IV.docx

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Martha Mc Kay

Chapter IV: Assessing and Diagnosing Abnormality Assessment: the process of gathering information about people’s symptoms and their possible causes. Diagnosis: A label attached to a set of symptoms that tend to occur together. Gathering Information: I. Symptoms and History: current symptoms and their severity and chronicity, interference with functioning, coping methods, recent events, history of psychological problems, family history of disorders II. Physiological and Neurophysiological Factors: physical examination, drug use, cognitive functioning and intellectual functioning (relevant to making a differential diagnosis: a determination of all the possible disorders) III. Sociocultural Factors: social resources available, sociocultural background (acculturation: extent to which a person identifies with his/her group of origin and its culture or with the dominant, mainstream culture)affect the presentation of and responses to problems, can cause stress for family Assessment Tools: - To understand and gain information of predisposing factors (family history, prolong homelessness), precipitating factors (traumatic event, loss/rejection), and perpetuating factors (isolation, stress) I. Clinical Interviews: initial interview (intake interview/mental status exam), may encounter resistance on the part of the client or client may have strong interest in the outcome and thus bias their presentation of information a) Unstructured: consisted of few open-ended questions, vary from one assessor to the nexthard to compare information b) Structured: consisted of a series of questions about symptoms he/she is experiencing/has experienced (Ex. Diagnostic Interview Schedule (DIS), Structured Clinical Interview for DSM) II. Cognitive, Symptom, and Personality Tests: - Validity: the accuracy of a test in assessing what it is aiming to measure  Face validity: test appears to measure what it is supposed to measure  Content validity: test assesses all important aspects of a phenomenon  Concurrent validity: test yields the same results as other measures of the same behaviour, thoughts, or feelings  Predictive validity: test predicts the behaviour it is supposed to measure  Construct validity: test measures what it is supposed to measure, not something else - Reliability: An indicator of the consistency of a test in measuring what it is supposed to measure  Test-retest reliability: test produces similar results when give at two points in time  Alternative form reliability: two versions of the same test produce similar results  Internal reliability: different parts of the same test produce similar results  Inter-rater/inter-judge reliability: two or more raters/judges who administer and score the interview/test come to similar conclusions when evaluating same people 1. Neuropsychological Tests: paper-and-pencil tests  Bender-Gestalt Test: assess sensorimotor skills by having clients reproduce a set of nine drawings, clients with brain damage may rotate or change the drawings 2. Brain-Imaging Techniques: used to determine brain injury/tumour  Computerized tomography (CT): X-ray beams passed through the person’s head in a single plane from different angles and the amount of radiation absorbed by each beam is measuredconstruction of a slice of the brain; provide only an image of the structure, not activity  Positron-emission tomography (PET): injects patients with a harmless radioactive isotope (FDG) that travels through blood to the brain and accumulate in the active parts, positrons are emitted as FDG decays; can be used to show differences in the activity level of the specific areas of the brain  Magnetic resonance imaging (MRI): creates a magnetic field around the brain that causes the realignment of the hydrogen atoms in the brain; no exposure to radiation or isotopes, safe to use repeatedly, provides detailed pictures of the anatomy of the brain and pictures of the activity and functioning in the brain 3. Intelligence Tests: used to get a sense of a client’s intellectual strengths and weaknesses; designed to measure basic intellectual abilities like abstract reasoning, verbal fluency, spatial memory  What is meant by intelligence?  Biased in favour of middle and upper-class educated European North Americans 4. Symptom Questionnaires: quick assess of a person’s symptoms  Beck Depression Inventory (BDI): most common for depression; asks the respondent current feelings which are then scored to indicate level of depressive symptoms; does not differentiate from anxiety and other disorders, cannot diagnose; good test-retest reliability, easy to administer, quick  Addictive Behaviours Questionnaire (ABQ): standard self-report measure to assess a client’s substance use problems; designed to screen for driven, repetitive, preoccupying, and out of control behaviours with adverse consequences 5. Personality Inventories: questionnaires meant to assess people’s typical ways of thinking, feeling, and behaving  Minnesota Multiphasic Personality Inventory (MMPI): present respondents with sentences describing moral and social attitudes, behaviours, psychological states, and physical conditions and ask them to respond true, false, or can’t say; developed empirically; high test-retest reliability, but healthy based on people from US  Bagby (analysis of MMPI): (1) depression scale score can distinguish major depression and bipolar groups from schizophrenia group; (2) group asked to fake schizophrenia were detected by the validity scales; (3) more effective in detecting feigned schizophrenia than depression; (4) when taught about the validity scales, non-clinical participants can avoid detection 6. Projective Tests: based on assumption that people will interpret ambiguous stimulus in line with their current concerns and feelings, their relationships with others, and their conflicts or desires; project issues when describing the content  Rorschack Inkblot Test: ask what patients see in ten cards each containing a symmetrical inkblot in black, grey, and white or in color, what it makes them think of , and what it means to them (content, stylethemes, concerns)  Thematic Apperception Test (TAT): client asked to make up a story about
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