Transcript Clinical Assessment and Diagnosis

Clinical Assessment and
Diagnosis
Chapter 3
Abnormal Psychology
Clinical Assessment

Protocols used for evaluation and
measurement
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Assessing/diagnosing psychological
disorders
Getting Started
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What brings the client to the provider?
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Discussion of the presenting problem
and the client’s history
Concepts in Assessment
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Reliability: the consistency of measurement
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Validity: does it measure what it is meant to
measure?
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Standardization: comparing individuals with
similar persons; asking questions in a
consistent manner
The Clinical Interview
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Current and past
behavior
Emotions and
attitudes
A detailed history
The presenting
problem
Significant life events
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Childhood
information and
family history
 Sexual development
 Religious
beliefs/cultural
background
 Educational history
The Mental Status Exam
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1. Appearance and Behavior- motor behavior,
movements
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2. Thought process- rate/flow of speech;
coherence; any evidence of delusions/hallucinations?
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3. Mood and Affect- what is the mood and is it
consistent? What is affect like and is it appropriate?
The Mental Status Exam
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Intellectual functioning: vocabulary, use
of language; general sense of cognitive
abilities
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Sensorium: Awareness of immediate
surroundings; Oriented x3? (Person, place,
time)
Issues to Consider
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Is the client presenting the central
issues? Are there other issues the client
sees as unimportant?
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Establishing rapport
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Confidentiality: Scope and limitations
Other Clinical Interviews
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Interviews or instruments specific to a
particular disorder or concern: to learn
the specific symptoms and their severity
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Anxiety Disorders Interview Schedule- questions
specific to compulsions and obsessions
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Eating Disorder interviews/scales
Physical Exam
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Physical problems may mimic psychological
disorders
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Thyroid issues
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Brain lesions/tumors
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Dementia
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Drug induced conditions
Behavioral Assessments
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Observing the client in specific contexts,
in real life settings or simulated situations
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Asking others to fill out behavior
“checklists”
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Often used with children: school and home
visits
Self-Monitoring
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Clients may be asked to keep a log of
their thoughts/behaviors
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When the behaviors occur in private
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To note frequency, severity, and “triggers”;
for self-reflection
Overview of Psychological Tests
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Projective Tests
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Personality Inventories
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Intelligence Tests
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Neuropsychological Tests
Projective Tests
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Client “projects” thoughts and feelings- to
reveal unconscious thoughts
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Rorschach (ink blot test)
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Thematic Apperception Test (TAT)
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Critique: limited reliability/validity; not directly linked
to the process of diagnosis
Personality Inventories
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Comparing an individual’s score with the
pattern of responses of those with
diagnosed psychological conditions
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MMPI: Minnesota Multiphasic
Personality Inventory
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567 true/false questions
MMPI
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Sample Questions:
I often think I’m being followed
 I am often happy for no reason
 Sometimes I get so mad I want to swear
 I sometimes throw up after meals
 Evil spirits possess me at times
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MMPI: Scales
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Clinical Scales:
 1: Hypochondriasis
 2: Depression
 3: Hysteria (Conversion)
 4: Psychopathic Deviant
 5: Masculinity/Femininity
 6: Paranoia
 7: Psychastenia (Anxiety)
 8: Schizophrenia
 9: Hypomania
 0: Social Introversion
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Lie Scale;
Infrequency Scale (to detect
random answers);
Defensiveness Scale
MMPI
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Results in a “code type”
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Looking at answers left blank
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Excellent reliability, good validity
Neuropsychological Tests
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Neuroimaging
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CAT scans/MRI: to assess brain damage
and to look at the structures of the brain
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PET scans: the functioning/activity of the
brain
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EEG: brain waves
Issues in Diagnosis
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Diagnostic and Statistical Manual
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Reliability/Validity
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Some diagnoses have greater
reliability/validity than others
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Personality Disorders tend to have lower
reliability
Diagnostic and Statistical Manual
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I and II were not widely used; lacked
precision, were unscientific, and had little
reliability
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DSM III: 1980: more atheoretical; more
precise descriptions; reliability/validity
studies
Axes 1-5
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Five “Axes” or Dimensions
Axis I: The Disorder
 Axis 2: Personality Disorder/MR
 Axis 3: Medical Conditions
 Axis 4: Problems: Psychosocial &
Environmental
 Axis 5: Global Assessment of Functioning
(Scale)
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Critique of the DSM
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Culturally sensitive?
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Stigma of labels
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“Fuzzy” categories and co-morbidity
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Categories based more on history than
current science? (Kraeplin’s dichotomy)
DSM-V
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In progress
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Various workgroups: clinicians and
researchers
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Revisions/new additions