Transcript Durand and Barlow Chapter 3: Clinical Assessment

Chapter 3:
Clinical Assessment &
Diagnosis
Amber Gilewski
Tompkins Cortland Community College
Assessing Psychological
Disorders
Purposes of Clinical Assessment
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To understand the individual
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To predict behavior
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To plan treatment
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To evaluate treatment outcome
Key Concepts in Assessment
Reliability
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Consistency is measurement
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Examples include test-retest & inter-rater reliability
Validity
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What an assessment approach measures & how well it does so
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Examples include concurrent/descriptive and predictive validity
Standardization and Norms
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Ensures consistency in the use of a technique
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Provides population benchmarks for comparison
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Examples include structured administration, scoring, and
evaluation procedures
The Clinical Interview
Clinical Interview
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Most common clinical assessment method
Mental Status Exam
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Appearance and behavior
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Thought processes
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Mood and affect
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Intellectual functioning
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Sensorium (awareness of environment)
Clinical Interview (continued)
Confidentiality – between patients &
mental health professionals; protected by
law in most instances
(i.e. except in Tarasoff’s law)
Types of interviews: unstructured &
semistructured clinical interviews
Physical Examination
Rules out medical explanations for
psychological disorders
Examples: toxic state, hyperthyroidism,
hypothyroidism, brain tumors, drug
ingestion
Behavioral Assessment
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Focus on the present – Here and now
Direct observation of behavior-environment
relations
Purpose is to identify problematic behaviors and
situations
Identify antecedents, behaviors, and
consequences
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Can be either formal or informal
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Self-monitoring vs. being observed by others
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Problem of reactivity using direct observation
Psychological Tests
Psychological Testing
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Must be reliable and valid
Projective Tests – Roots in Psychoanalytic Tradition
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Project aspects of personality onto ambiguous test
stimuli
Require high degree of inference in scoring and
interpretation
Examples
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The Rorschach Inkblot Test, Thematic Apperception
Test
Reliability and validity data tend to be mixed
Psychological Tests (continued)
Personality Tests
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Minnesota Multiphasic Personality Inventory
(MMPI, MMPI-2, MMPI-A)
Extensive reliability, validity, and normative
database
Intelligence Tests
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Nature of intellectual functioning and IQ
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First tests developed by Alfred Binet
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Weschler developed more tests used
with adults & children
Verbal and performance domains
Neuropsychological Testing
Purpose and Goals
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Assess broad range of skills and abilities
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Goal is to understand brain-behavior relations
Examples
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The Bender Visual Motor Gestalt Test
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The Luria-Nebraska Battery
Problems with Neuropsychological Tests
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False Positives & False Negatives
Neuroimaging
Neuroimaging: Pictures of the Brain
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Allows for a window on brain structure and function
Imaging Brain Structure
Computerized axial tomography (CAT or CT scan) :
utilizes X-rays
Magnetic resonance imaging (MRI): Utilizes strong
magnetic fields & better resolution than CT scan
Neuroimaging (continued)
Imaging Brain Function
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Positron emission tomography (PET)
Single photon emission computed tomography
(SPECT)
Both involve injection of radioactive isotopes
Isotopes react with oxygen, blood, and glucose in the
brain
Functional MRI (fMRI) – Brief changes in brain
activity; provides structural & functional images
Diagnosing Psychological
Disorders
Diagnosis – identifying a general class of
problems together
Prognosis – likely future course of a disorder
Classification – most widely used by mental
health professionals is the DSM-5
DSM-5 (2013)
DSM-5 is largely unchanged from DSM-IV
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Divided into three main sections
How to use the manual
Disorders
Description of disorders
Most notable change is the removal of the
multiaxial system
DSM-5 introduces cross-cutting
dimensional symptom measures
Includes social and cultural considerations
Criticisms of the DSM-5
The Problem of Comorbidity
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Defined as two or more disorders for the
same person
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High comorbidity is the rule clinically
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Threatens the validity of separate diagnoses
Labeling Issues and Stigmatization