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PYB309 - Individual differences and assessment > 4. Clinical Assessment: Methods and purpose > Flashcards

4. Clinical Assessment: Methods and purpose Flashcards

1
Q

what are methods of clinical assessment?

A
  • Clinical interview
  • Personality Assessments
  • Questionnaires
  • Corroborative reports
  • Self-report
  • Self-monitoring forms
  • Observation
  • Measuring Process and Outcome of therapy
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2
Q

what are the purposes of clinical interviews?

A
  • Mental Status Examination
  • Diagnosis
  • Risk assessment
  • Formulation
  • Understand client’s goals for assessment or therapy
  • Understand process issues that might guide the course of therapy
  • Demographics
  • evidence based
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3
Q

what is mental status examination in clinical interviews?

A

o doesn’t give you a diagnosis

o just gives to a pathology

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4
Q

what is diagnosis in clinical interviews?

A

does not give you full information, so you wouldn’t base the therapy entirely on the diagnosis. But is very important and informative in guiding a treatment plan

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5
Q

what is risk assessment in clinical interviews?

A

risk to self-harm, suicide and to others

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6
Q

what is formulation in clinical interviews?

A

case conceptualisation or explanation of what psychological processes a person has had

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7
Q

what are demographics in clinical interviewing?

A

age, level of education

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8
Q

what links into treatment plans?

A

diagnosis, formulation, risk assessment, demographics, evidence based

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9
Q

what are the three phases of a semi-structured clinical interview?

A

opening, middle, end

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10
Q

what is involved in the opening of a semi-structured clinical interview?

A

o warm up and rapport building

o assess the suffering, empathise

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11
Q

what is involved in the middle of a semi-structured clinical interview?

A

history, mental status, assessment, determine client’s level of insight

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12
Q

what is involved in the end of a semi-structured clinical interview?

A

o summarise conclusions

o focus on goals and hope for future

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13
Q

what are the areas covered by a clinical interview?

A
  • Ask about presenting problem (what brings them in today)
  • Explore current psychological functioning and symptom formation (identify diagnoses and differential diagnoses)
  • Mental Status Examination throughout interview
  • Risk assessment
  • Personal history, including critical developmental incidents, as well as family, educational, medical, psychiatric and social histories – looking for psychological mechanisms as well as events
  • Current social systems
  • Strengths, competencies and abilities
  • Client’s goals for assessment or therapy
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14
Q

what is involved in Mental status examination?

A

A structured summary of your own observation of the client

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15
Q

what are aspects that you should observe in mental status examination?

A 
o	Appearance
o	Behaviour 
o	Thought Form
o	Thought Content
o	Perception
o	Affect\Mood
o	Orientation
o	Judgement
o	Insight
o	Intelligence
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16
Q

what do you observe when observing appearance and behaviour?

A 
•	Dress
•	Self-care
•	Eye contact
•	Motor activity 
o	Agitation
o	Retardation
•	Movements
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17
Q

what do you observe when observing mood and affect and behaviour?

A

Cues: behaviour, appearance, facial expression, expression, presentation

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18
Q

what do you observe when observing thought and behaviour?

A

content and form

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19
Q

what do you observe when observing perception and behaviour?

A 
•	Sensory distortions and illusions
•	Hallucinations:
o	hearing
o	vision (implications)
o	smell, taste and touch
•	Other abnormal perceptions
•	Depersonalisation and derealisation
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20
Q

what do you observe when observing cognition and behaviour?

A
  • Orientation to time, place and person
  • Attention and concentration
  • Capacity for abstraction and reasoning
  • Current functioning in relation to previous functioning
  • Tools – MMSE, proverbs, serial 7s
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21
Q

what do you observe when observing insight and behaviour?

A

• Understanding and Attitudes:
o towards the problem
o towards the consequences and limitations imposed by the problem/disorder
o towards any help offered

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22
Q

what does affect refer to in MSE?

A

• Affect refers to characteristics communicated during the interview – the interpersonal dimension in the here and now.

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23
Q

what observing thought and behaviour what does the content aspect observe?

A

o Unusual content
o Overvalued ideas
o Delusions

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24
Q

what observing thought and behaviour what does the form aspect observe?

A 
o	Rate, responsivity and spontaneity
o	Coherence – use of standard grammatical forms and sentence structure
o	Capacity to sustain train of thought 
o	Circumstantiality
o	Tangentiality
o	Flight of ideas
o	Thought block
o	Word salad
o	Unusual word usage – neologisms
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25
Q

when assessing attention and concentration when observing cognitions is MSE what are you looking for?

A

o distraction due to intrusive thoughts
o impaired reasoning
o impaired concentration
• Memory and whether a good historian

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26
Q

when assessing attention and concentration when observing cognitions is MSE what are you looking for?

A

o distraction due to intrusive thoughts
o impaired reasoning
o impaired concentration
• Memory and whether a good historian

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27
Q

what are risk factors observed in suicide risk assessment?

A 
o	Ideation, Plans, Intent to act, Means,
o	Acute stress
o	Depression
o	Impulse control problems
o	Humiliation/embarrassment
o	Hopelessness
o	Use of substances
o	Previous models of self-harm
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28
Q

what are protective factors in suicide risk assessment?

A

o Beliefs (eg moral or religious)
o Family (eg children)
o Social Support
o Upcoming positive experiences to look forward to

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29
Q

what is the purpose of a diagnosis?

A
  • Description of levels of psychopathology
  • Communication
  • Guide Treatment
  • Inform prognosis
  • Guides Research
  • Identifying capacity of someone to stand trial
  • Cognitive or functional impairment
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30
Q

what are the key questions for a diagnosis?

A
  • What are the primary symptoms?
  • What is the approximate duration of the disorder?
  • How severe are the symptoms?
  • Has a specific cause or precipitant for the symptoms been identified?
  • Are there differential diagnoses?
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31
Q

what is involved in diagnostic reasoning

A

cues, inferences, patterns, hypothesis, inquiry conclusion and formation which all lead to evidence

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32
Q

what are the categories of mental disorders?

A

Normative/statistical

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33
Q

what are mental disorders?

A

A significant behaviour that occurs in an individual that is associated with distress or disability, or an increased risk for suffering death, pain, disability, or an important loss of freedom. This syndrome must not be due to a culturally sanctioned response.

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34
Q

what, generally, are examples of mental disorders?

A
  • Impaired functioning/adaptability

* Distress

35
Q

what are categorical classification/system of mental disorders?

A

Presence/absence of a disorder

• Either you are anxious or you are not anxious.

36
Q

what are dimensional classification/system of mental disorders?

A

o Rank on a continuous quantitative dimension

• How anxious are you on a scale of 1 to 10?

37
Q

why are dimensional systems preferred when assessing mental disorders

A

Dimensional systems may better capture an individual’s functioning but the categorical approach has advantages for research and understanding

38
Q

when was DSM 1 made?

A

1952

39
Q

what did DSM 1 reflect?

A

Myers psychobiological view that Disorders are cause by personality “REACTION”

40
Q

when was DSM 2 made?

A

1968

41
Q

what does DSM 2 reflect?

A

same as DSM 1 but the reference to ‘reaction’ was removed

42
Q

when was DSM 3 published

A

1980

43
Q

Hoe does DSM 3 differ from DSM 1 and 2?

A

It is Free from theories of etiology and Initiates use of Multi-axis system

44
Q

when was DSM 3-R published?

A

1987

45
Q

why was DSM 3-R published?

A

revision made to clarify diagnoses

46
Q

when was DSM 4 published?

A

1994

47
Q

what were the characteristics of DSM 4?

A

It was Categorical, had Cultural and ethnic considerations and was Not based on deviant behaviors

48
Q

when was DSM 5 published?

A

2013

49
Q

how does DSM 5 differ from the other DSMs?

A

o - Published 2013
o - changes in diagnostic criteria (e.g.
o - removal of criteria e.g. bereavement is no longer an exclusion criteria for depression

50
Q

what does DSM-5 list?

A

approximately 400 disorders

51
Q

what does DSM 5 describe?

A

• Describes criteria for diagnoses, key clinical features, and related features that are often, but not always, present

52
Q

what is required for someone to be diagnosed with a major depressive disorder?

A

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.

53
Q

what are the symptoms of major depressive disorder?

A

depressed mood, markedly diminished interest or pleasure in all, significant weight loss when not dieting or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthiness or excessive or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death

54
Q

Depressed mood in major depressive disorder

A

Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

55
Q

Markedly diminished interest or pleasure in major depressive disorder

A

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

56
Q

significant wight loss when not dieting or weight gain in major depressive disorder

A

(e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

57
Q

insomnia or hypersomnia in major depressive disorder

A

nearly every day

58
Q

psychomotor agitation or retardation in major depressive disorder

A

(observable by others, not merely subjective feelings of restlessness or being slowed down).

59
Q

feelings of worthiness or excessive or inappropriate guilty in major depressive disorder

A

which may be delusional) nearly every day (not merely self-reproach or guilt about being sick

60
Q

diminished ability to think or concentrate in major depressive disorder

A

or indecisiveness, nearly every day (either by subjective account or as observed by others).

61
Q

Recurrent thoughts of death in major depressive disorder

A

not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

62
Q

what can the symptoms of major depressive disorder cause?

A

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

63
Q

what is the episode of major depressive disorder not attributable to?

A

The episode is not attributable to the physiological effects of a substance or to another medical condition.

64
Q

What is the relationship between responses of significant loss, and major depressive disorder?

A

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

65
Q

what is reliability?

A

Reliability refers to the consistency of measurements, including diagnostic decisions e.g. inter-rater reliability

66
Q

what is validity?

A

Validity refers to whether or not accurate statements and predictions can be made from knowledge of membership class

67
Q

what does a diagnosis and formulation do?

A

diagnosis - describes

formulation - explains

68
Q

what, specifically, does formulation do?

A

Integrates diagnostic and non-diagnostic clinical information from history and provides a basis for a treatment plan

69
Q

what is formulation based on?

A

a theoretical framework

70
Q

how is formulation undertaken?

A

Identify critical events in a person’s life and link these to the presenting problems by key psychological mechanisms. Then determine a balance between comprehensive and parsimonious

71
Q

what are the steps to formulation?

A
  1. Presentation: Current expression of problem
  2. Pattern of behaviour
  3. Predisposition: Pre-morbid events that have lead to the presentation
  4. Precipitation: Triggers for current presentation
  5. Perpetuation: Maintaining factors of problem/s
  6. Potentials: Client/family/system strengths
  7. Prognosis
72
Q

What is an example of the CBT Formulation?

A

predisposing factors, precipitating factors, perpetuating factors

73
Q

What are predisposing factors in CBT formulation?

A

o Relationship A à modelling of catastrophic cognitions
o Relationship B à modelling of avoidant behaviour
o Event A à behaviour A à -ve reinforcement of avoidant behaviour

74
Q

What are precipitating factors in CBT formulation?

A

Trigger event à catastrophic cognitions

75
Q

What are perpetuating factors in CBT formulation?

A

o Catastrophic cognitions and low self-efficacy à avoidant behaviour
o Avoidant behaviour à -ve reinforcement, fails to challenge catastrophic cognitions and self-efficacy
o Avoidant behaviour à relationship problems à low self-worth à low self-efficacy

76
Q

what is SORCK funcitonal analyses of behavioural formulation?

A 
S = stimuli i.e. antecedents
O = organism i.e. internal factors
R = response i.e. target  behaviour
C = consequences i.e. what happens
K = Contingencies
77
Q

what is involved in the stimuli of the SORCK functional analyses?

A

Historical, contextual or immediate

78
Q

what are the consequences in the SORCK functional analyses?

A

Immediate and delayed

79
Q

what are examples of personality inventories self-report questionnaires?

A 
o	BDI or BDI-II
o	HADS
o	CES-D
o	DASS
o	PHQ-9
80
Q

what are examples of personality inventories clinician rating questionnaires?

A

HAM-D

81
Q

what are examples of personality inventories generic case finders questionnaires?

A

MHI
GHQ
K10

82
Q

What are the ABCs in self-monitoring of ABCs?

A 
A 
(Antecendents)
B 
(Beliefs) % believed
C 
(Emotional Consequences)
83
Q

what did Michael Lambert develop with regards to accessing process and outcome of therapy?

A

outcome Questionnaire (OQ45)

84
Q

what did scott miller develop with regards to accessing process and outcome of therapy?

A

o Outcome Rating Scale (ORS)

o Session Rating Scale (SRS)

PYB309 - Individual differences and assessment (12 decks)

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