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Chapter 3

Abnormal Psych Chapter 3 Assessment and Diagnosis.docx

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Department
Psychology
Course Code
Psychology 2030A/B
Professor
David Vollick

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Chapter 3:Assessment and Diagnosis Clinical Assessment • gathering information about a person and his/her environment to make decisions about the nature, status, and treatment of psychological problems • begins with a set of referral questions that determine goals of assessment • selections of appropriate psychological tests and measurements Goals of Assessment -the patients age, medical condition, and description of his or her symptoms strongly influence the tools selected for assessment, but the psychologist's theoretical perspective also affects the scope of the assessment -although it is not the purpose of patient evaluation, the process of assessment sometimes has a therapeutic effect: as people begin to understand their emotions, behaviours and the links between them, their symptoms tend to improve -differential diagnosis is a process in which a clinician weighs how likely it is that a person has one diagnosis instead of another • what assessment procedures and instruments to administer • tailoring an assessment to types of symptoms, age and medical status • screening (identify psychological problems or predict the risk for future problems) -chart of how to find a good screening tool -in a screening assessment all members of a group are given a brief measure for which some identified cutoff score indicates the possibility of significant problems • diagnosis (identification of illness)- it requires the presence of a cluster of symptoms; diagnosis is made after a clinical interview with the patient -more extensive than screens and are designed to provide a more thorough understanding of a person's psychological status • differential diagnosis- when clinicians attempt to determine which diagnosis most clearly describes the patient's symptoms • treatment plan (individual's plan of care to meet mental health needs) -a clinical assessment that leads to a diagnosis usually includes the evaluation of symptom and disorder severity, patterns of symptoms over time, and the patient's strengths and weaknesses -behavioural psychologists also conduct a functional analysis of symptoms, which identifies the relations between situations and behaviour to aid in devising a treatment strategy • outcome evaluation- help us know whether patients are getting better, when treatment is "finished" or when a modification to an approach that is not achieving its aims is necessary -the same measures must be administered consistently over the course of treatment (individual measures should represent a range of outcomes -must be reliable and valid -both the degree of change and the patient's actual level of functioning after treatment must be assessed -clinical significance- the observed change actually is a meaningful improvement (Reliable Change Index) Cases of Misdiagnosis • deafness vs. intellectual disability- poor academic performance in grade 2 led to diagnosis of retardation and placement in a school for mentally impaired when really she had hearing loss • epilepsy vs. schizophrenia- had depressive symptoms and hallucinations and seizures • medication reaction vs. depression- developed depression after taking medication for heart problems • brain tumor vs. anorexia nervosa- seizure symptoms and brain scan revealed seizures • impact of clinical significance The Usual Properties of Assessment • standardization (it's all done the same way, helps with reliability) -normative comparisons- require comparing a person's score with the scores of a sample of people who are representative of the entire population or with the scores of a subgroup who are similar to the patient being assessed (if a person's score falls too far outside the range of the normative group, we can assume a problem exists) -standard deviation- how far away from the mean a score is; a score that is more than 2 SD's away from the mean is found in only 5% of the population and is considered meaningfully different from what is normal -self-referent comparisons- helps to trace severity of symptoms over time; equate responses on various instruments with the patient's own prior performance; also used to evaluate treatment outcome • reliability- consistency, or how well the measure produces the same result each time it is used -test retest reliability- consistency of scores across time, administer the same instrument twice to the same people over some consistent interval; then calculate the correlation coefficient (.80 or higher indicate a measure is highly reliable over time) -interrater agreement- we want to know that the patient's symptoms reflected his or her actual clinical status, not the bias of a specific clinician; ask two different clinicians to administer the same interview to the same patients • validity- the degree to which a test measures what it is intended to measure -construct- how well a measure accurately assesses a particular concept, not other concepts that may be related -criterion- how well a measure correlates with other measures that assess the same or similar constructs -concurrent- assesses the relationship between two measures that are given at the same time -predictive- ability of a measure to predict performance at a future date -to reach their answers, clinicians can make predictions based on statistical data or clinical observations -clinical prediction- relies on clinician's judgment -statistical prediction- results when a clinician uses data from large groups ofpeople to make a judgment about a specific individual Developmental and Cultural Considerations • age • people involved in testing- age, developmental status • nature of test chosen, the normative values against which patient scores are compared, the people involved in the testing process, and the testing environment can differ significantly depending on whether the person is a child or adult • "culturally fair" • ethics and responsibility- assessments must adhere to theAmerican Psychological Association Code of Ethics; section 9 of that code requires that psychologists only use tests on which they have received training -it would be unethical for a psychologist to give a test if he has not been trained to give the test, the test had poor reliability and validity, the test was designed for adults but the psychologist used it to test a teenager -informed consent- indicates that the person to be tested understands the test's purpose, it's related fees, and who will see the results Assessment Instruments • self-report measures (ask patients to evaluate their own symptoms) • clinician-rated measures (clinician rates symptoms) • subjective responses (what the patient perceives) vs. objective responses (what can be observed) • test battery- the group of tests, when a number of tests are given together • clinical interviews- conversation between an interviewer and a patient to gather information and make judgments related to assessment goals -purpose: screening, diagnosis, treatment planning or outcome evaluation -types of interviews 1. unstructured- conclusions unreliable- questions vary across patients -the clinician decides what questions to ask and how to ask them -typically the initial interview to get to know each other and develop a working relationship -benefit=flexible, limitation= unreliable 2. structured- each patient receives same set of questions, usually with the goal of establishing a diagnosis -semi structured interview-after the standard questions, the clinician uses less structured supplemental questions -increase the reliability of the interview process -drawback-less flexible 3. open/closed-ended questions Psychological Tests • Objective Personality Tests- questions are quite obvious of what is being asked 1. Minnesota Multiphasic Personality Inventory (MMPI)- empirical keying-developed statistical analysis to identify items and patterns of scores that differentiated various groups=discriminates between groups of people -includes statistical scales to evaluate a number of test-taking behaviours -nine clinical subscales + faking good and faking bad, lie scales 2. The Million Clinical Multiaxial Inventory (MCMI)- lacks fit with the DSM system and categories and test is culturally biased; true/false inventory with 8 personality styles, 3 pathological personality syndromes, 9 symptom disorders scales -prefer it to the MMPI because it takes less time to complete • Projective Tests -from psychoanalytic theory- respond to ambiguous stimuli 1. ThematicApperception Test (TAT)- consists of 31 black and white pictorial cards and the patient is asked to make up a story about the image -the examiner interprets each story without a formalized scoring system and is free to evaluate the response from within his or her own theoretical orientation 2. Rorschach Inkblot Test- shown ambiguous stimuli and then projects a unique interpretation onto them that reflects his/her underlying unconscious processes and conflicts -poor normative data- break the ice initially -standardized administration and scoring of the test=comprehensive system -25% of the Exner's Comprehensive System scores are not considered reliable, "the
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