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Chapter 4

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PSYC 3140
Joel Goldberg

Chapter Four  Assessment: the process of gathering information about people’s symptoms and the possible causes of those symptoms. It is used to determines the appropriate diagnosis for a person’s problem  Diagnosis: a label attached to a set of symptoms that tend to occur together  Applying a psychiatric diagnosis to a person has a number of dangers and problems such as the stigmatizing effects of having a psychiatric diagnosis  Three types of information guide the formation of a diagnosis: 1. History  Clinician would ask about current symptoms (severity and chronicity), how the symptoms are interfering with ability to function  Also important to know family history of disorders 2. Physiological  Such as heavy drinking 3. Neurophysiological  Tremors, weakness etc.  Criteria for diagnosing most major psychological disorders require the symptom be severe and pervasive enough to interfere with the person’s ability to function in daily life. Information about the pervasiveness and duration of symptoms help formulate a treatment plan. It is also helpful to know how patient is coping with the stress of life and the symptoms  Frequently, patients turn to methods of coping that are actually creating more problems. i.e.: alcohol  Physical examination is required to determine if patient has medical conditions that create psychological symptoms. Example: some brain tumors create symptoms similar to schizophrenia  There are no definitive biological tests that determine whether disorders exist or not. Biological tests can just tell us whether a medical disease is causing the psychological symptoms as side effects  Clinician also needs to know about any drugs the patient is taking, because some symptoms could be cause by certain drugs –legal or illegal  Clinicians also assess client’s cognitive functioning and intellectual abilities  Differential diagnosis: a determination of which several possible disorders an individual may have. Example: determine whether or not symptoms of paranoia are due to cognitive deficits, such as memory loss, or due to schizophrenia has a major impact on the diagnosis and type of treatment  Clinicians also ask about the social resources of patient- friends, family etc.  Acculturation: the extent to which a person identified with his or her group of origin and its culture or with the dominant, mainstream culture  Much of the information for assessment is gathered in an initial interview called an intake interview or mental status exam  The interview can be unstructured with only a few open-ended questions to obtain non-verbal indicators of possible problems.  Interviewing family is important, especially when client is a child, since they can’t express emotions as well  Structure interview: clinician asks a series of questions about symptoms he or she is experiencing. The questions are standardized  Examples: Diagnostic Interview Schedule (DIS) and the Structure clinical interview for DSM  Resistance: a limitation to structure/unstructured interviews. When client is selective on information provided, or biased. Such as the case of a child custody battle  two criteria used to evaluate quality of a tests: 1. Validity: the accuracy of a test in assessing what it is aiming to measure. The best way to determine this is to see if test results yield the same information as an objective and accurate indication  Face validity: when on face value the items seem to be measuring what the test is intended to measure  Content validity: extent to which a test assesses all the important aspects of a phenomenon that it purports to measure  Concurrent validity: extent to which a test yields the same results as other measures of the same behaviour, thought or feeling  Predictive validity: a test that is good at predicting how a person will think, act or feel in the future  Construct validity: extend to which the test measure what is supposed to be measured, not something else 2. Reliability: an indicator of consistency of a test in measuring what it is supposed to measure  Test-retest reliability: index of how consistent the results of a test are over time  Alternative form reliability: when people’s answers to different forms of a test are similar  Internal reliability: when answers are similar in different parts of the same test  Inter-rater reliability: also known as inter-judge reliability, different judges should come to similar conclusions when evaluating the same people  Neuropsychological tests detect specific cognitive and fine-motor deficits such as an attentional problem or a tendency to ignore items in one part of the visual field  A common example: Bender-Gestalt test, assesses sensorimotor skills by having them produce nine drawings. Clients with brain damage may change parts of the drawing or be unable to reproduce it.  The test doesn’t identify the specific type of brain damage  Brain scans are used to determine location of brain damage or tumor. Blood tests determine medical problems that contribute to certain psychological symptoms (low blood sugar)  Computerized tomography: (CT) is an enhancement of X-ray procedures. In a head CT, narrow X-ray beams are passed through the person's head in a single plane from a variety of angles. The amount of radiation absorbed by each beam is measured, and from these measurements a computer program constructs an image that looks like a slice of the brain. By taking many slices of the brain, the computer can reconstruct a three- dimensional image. A CT scan can reveal brain injury, tumours, and structural abnormalities. The two major limitations of CT technology are that it exposes patients to X-rays, which can be harmful, and it provides only an image of the structure of the brain, rather than an image of the activity in the brain.  Positron-emission tomography (PET): can provide a picture of activity in the brain. PET requires injecting the patient with a harmless radioactive isotope, such as fluorodeoxyglucose (FDG). This substance travels through the blood to the brain. The 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, called positrons, are emitted as the isotope decays. These positrons collide with electrons, and both are annihilated and converted to two photons, travelling away from each other in opposite directions. The PET scanner detects these photons and the point at which they are annihilated and constructs an image of the brain, showing the areas that are most active. PET scans can be used to show differences in the activity level of specific areas of the brain between people with a psychological disorder and people without a disorder. i.e.: Serotonin is abnormally regulated during major depressive episodes, with the specific observation that extracellular levels of serotonin are low in individuals during an episode  Magnetic resonance imaging (MRI): holds several advantages over both CT and PET technology. It does not require radiation or injection of radioisotopes. Safe for repeated use. It provides much more finely detailed pictures of the anatomy of the brain than do other technologies, and it can image the brain at any angle. It can also provide pictures of the activity and functioning in the brain. MRI involves creating a magnetic field around the brain that is so powerful that it causes a realignment of hydrogen atoms in the brain. When the magnetic field is turned off and on, the hydrogen atoms change position, causing them to emit magnetic signals. These signals are read by a computer, which reconstructs a three-dimensional image of the brain. Researchers are using MRI to study functional and structural brain abnormalities in almost every psychological disorder .  Intelligence tests: are used to get a sense of a client’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected. Tests are used in school to identify children with intellectual difficulties and gifted children. Some examples are Wechsler Adult Intelligence Scale, the Stanford-Binet Intelligence Test, and Wechsler Intelligence for Children.  Tests measure: special memory, abstract reasoning, verbal fluency.  Criticism: no talents or skills are tested. Also, biased in favour of middle and upper class  Symptom questionnaire: a quick way of assessing what symptoms a person is experiencing  Most common one is the Beck Depression Inventory or BDI which has 21 items  Critics of the BDI have argued that it does not clearly differentiate between the clinical syndrome of depression and the general distress that may be related to an anxiety distress that may be related to an anxiety disorder or several other disorders  Personality inventories: usually questionnaires that are meant to assess people’s typical ways of thinking, feelings, and behaving.  MMPI was developed empirically, meaning that large group of possible items were given to people without psychological disorder and to people with various psych
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