Textbook Notes (369,067)
United States (206,185)
Psychology (295)
01:830:340 (47)
Chapter 3


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Sara Campbell

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Chapter 3: Clinical Assessment, Diagnosis and Research Clinical Assessment- systematic evaluation and measurement of psychological, biological, and social factors in a persons presenting with a possibly disorder Diagnosis- determining whether the problem afflicting the individual meets all the criteria for a psychological disorder in the DSM Key Concepts of Assessment A. reliability- the degree to which a measure is consistent ■ interrater reliability- two or more raters give the same diagnosis ■ test-retest reliability- getting the same results on a clinical test B. validity- whether something measures what it is designed to measure ■ concurrent (descriptive) validity- comparing the results of an assessment with the results of others that are better known helps determine the validity of the first measure i. ex a long IQ test gives the same results as a short IQ test ■ predictive validity- how well your assessment will tell you what will happen in the future i. ex does IQ test predict success C. standardization- process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measurements The Clinical Interview ■ gather info on presenting problem, past history A. mental status exam- preliminary test of a clients judgement, orientation to time and place, and emotional and mental state conducted in the initial interview 1. appearance and behavior i. dress, posture, facial expression ii. ex psychomotor retardation (slow motor movement) may indicate depression 2. thought processes i. rate/flow of speech, scattered ideas ii. loose association (derailment) disorganized speech pattern common in schizophrenia iii.delusions- distorted views on reality a. delusions of persecution- people are out to get them b. delusions of grandeur- thinks they are all powerful c. ideas of reference- everything everyone does relates to them (conversation of strangers must be about you) d. hallucinations 3. mood and affect i. mood- predominant feeling state of individual ii. affect- the feeling state that accompanies what we say at a given point iii.are they appropriate? 4. intellectual fx i. vocabulary, memory 5. sensorium i. general awareness of our surroundings ii. aware of who we are, where, date time B. Semistructured Clinical Interviews -made up of standardized questions that purpose to be consistent in diagnosis, disadvantage is that it takes away spontaneous info from just two people talking 1. Physical Examination- many patients first go and are recommended to go to a physician first, disorder may be caused by imbalance of meds onset of a disease, ex hypothyroidism onset causes anxiety 2. Behavioral Assessment- measuring, observing, and systematically evaluating (rather than inferring) the clients thoughts, feelings, and behavior, in the actual problem, situation, or context i. useful for individuals who are not old enough to report their experiences ii. analog- when going to home or workplace of patient is not appropriate, clinicians arrange a similar setting iii.The ABC’s of Observation a. antecedent (ex mother asks son to put glass in sink) b. behavior (son throws glass) c. consequence (mother is unresponsive) d. informal observation- relies on the observer’s recollection and interpretation of events e. formal observation- involves identifying specific behaviors that are observable and measurable (called an operational definition) iv. self-monitoring- (self observation) people observe their own behavior to find patterns a. ex people trying to stop smoking record number of cigarettes a day and what leads them to smoke more b. behavior rating scales- used as assessment tools before treatment and also during treatment to see a change in behavior ○ ex Brief Psychiatric Rating Scale c. reactivity- when observing someone's behavior, your presence may change their behavior 3. Psychological Testing- determine cognitive, emotional and behavioral responses that may be associated with a disorder i. projective testing- used to asses the unconscious, use a variety of methods with ambiguous stimuli ( pictures) and clients are asked what do they see, theory is that people project their own feelings and reveal their unconscious a. Rorschach Inkblot- does not have good reliability or validity b. Thematic Apperception Test (TAT)- cards with pictures (one blank), clients asked to tell story about the card, revealing the unconscious, uses formal scoring system ii. personality inventories- self report questionnaire that assesses personal traits by asking respondents to identify descriptions that apply to themselves a. face validity- wording of the question tend to fit the information desired b. paul meehl pointed out that this is not important, important if people as a group with a disorder tend to answer a question in a certain way regardless of the question c. ex do your thoughts tend to be scattered versus have you ever been in love d. minnesota multiphasic personality inventory (MMPI)- most widely used based on an empirical approach (collection and evaluation of data) used T/F statements ○ performed on computer to inc reliability ○ includes a lie scale iii.intelligence testing a. Stanford-Binet Test (IQ) Intelligence Quotient test b. IQ- score on an intelligence test eliminating a persons deviation from average test performance (deviation from people of the same age) ○ mental age- based on answering of questions ○ chronological age- actual age c. low IQ score does not necessarily mean person is not intelligent (administered in english) d. tend to be reliable and valid 4. Neuropsychological testing-assessment of brain and NS functioning by testing an individuals performance of behavioral tasks i. Bender Visual-Motor Gestalt Test- childrens test where given a set of cards with shapes and instructed to copy what is on the card ii. rhythm test- asks person to compare rhythms therefore testing sound recognition, attention, and concentration iii.strength of grip test- compares grip of right and left hand iv. tactile performance test- place wooden blocks on a board blindfolded tests memory and learning v. tests are only useful for detecting organic damage vi. false positive- assessment error in which pathology is reported when none is actually present vii.false negative- assessment error in which no pathology is reported when one is actually present 5. Neuroimaging- ability to take pictures of brain structure (look for size and damage) and function (map blood flow and other metabolic activities) i. images of brain structure a. CAT (computerized axial tomography) shows blocks in brain, brain tumors, structural abnormalities, uses x rays b. MRI (Magnetic Resonance Imaging)- uses magnetic field, excites tissue and reaction is less in tissue that is damaged ii. images of brain functioning a. PET (positron emission tomography)- injection of isotopes that interact with blood O2 and glucose, brain metabolism b. single photon emission computed tomography (SPECT)- uses different tracer, less expensive but less accurate c. functional MRI (fMRI)- ability to see brain response to an event (ex seeing a new face) 6. Psychophysiological Assessment- measurable changes in the NS that reflect emotional or physiological events such as anxiety, stress, sexual arousal i. electroencephalogram (EEG)- measures electrical activity and firing of neurons a. event related potential (evoked potential)-response to a meaningful stimulus b. alpha waves- in a normal relaxed adult when walking, stress reduction treatments in
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