Application of Assessment in Clinical Settings wk 11

Question 1

Distinguish testing vs assessment

Answer 1

Testing: the obtaining of a score that can be compared to others on the basis of normative, nomothetic findings. Only uses a single scale.

Assessment: moves beyond testing, and uses scores to devise a treatment plan and create a coherent picture of patient. Uses variety of test scores to make a judgement.

Question 2

What reasons are there for asssessing someone?

Answer 2

1. describe current functioning
2. confirm,refute, or modify impressions formed by clinicians
3. identify therapeutic needs, highlight issues likely to arise in treatment, recommend forms of interventions and offer guidance about likely outcomes
4. aid in differential diagnosis
5. monitor treatment overtime to evaluate the success of
   interventions
6. manage risk(untoward treatment reactions,potential legal liabilities)
7. provide skilled, empathic assessment feedback as a therapeutic intervention in itself.

Question 3

why use standardised tests?

Answer 3

1) Clinicians are unreliable judges (dont always have the same judgement)
e. g. “…. We think we may say without exaggeration that these children’s diagnoses looked as if they had been drawn by chance out of a sack”

Question 4

What two overarching errors do clinicians make that render them unreliable judges?

Answer 4

Errors in gathering data and synthesising it.

Question 5

What is confirmatory evidence? How is this a ‘gathering data error?’

Answer 5

we make hypothesis and seek confirmatory evidence (confirmation bias). we naturally put aside evidence that doesnt support our hypothesis

Question 6

Why would preconceived ideas be an error in gathering data?

Give an example.

Answer 6

e.g. tendency to overpathologise: because patient is coming to help, we see everything as a symptom

(ties into tendency to see patterns when none exist)

Question 7

heuristics in clinical judgement:

What is anchoring? How is this an error in synthesising data?

Answer 7

The tendency to lock onto salient features in the patient’s presentation too early in the clinical reasoning process, and failing to adjust this initial impression in the light of later information.
Ties into confirmation bias.

Question 8

heuristics in clinical judgement:

What is availability and why is it an error in synthesising data?

Answer 8

look for only salient evidence (seeking confirmatory evidence)

Question 9

heuristics in clinical judgement:

What is representativeness and why is it an error in synthesising data ?

Answer 9

representativeness: look for data that matches relevant data.

Question 10

What is ‘prototypes’ referring to when we talk about errors in synthesising info.

Answer 10

we tend to compare with examples e.g. i remember i had a patient like that perhaps i could impose the same thing.

Question 11

Affect as a synthesising data error?

Answer 11

a we rely on feelings to interpret our data e.g. gender and race bias.

Question 12

What are diagnostic interviews?

Answer 12

• Fully or semi-structured
• Ensure coverage of the diagnostic criteria as specified by DSM-IV/DSM-5
• Few errors in gathering data
• Rules for scoring the interview are specified
• Few errors in synthesising data

Question 13

What is the name of the gold standard diagnostic interview to use?

Answer 13

Structured Clinical Interview for DSM-IV (SCID)

Question 14

Does the SCID have high reliability and validity?

Answer 14

Yes.
Reliability: good…
• Inter-rater agreement
• Test-retest reliability

Validity: good…
• Validity of diagnostic criteria

Question 15

What five types of tests do clinicans use ?

Answer 15

• Diagnostic interviews
• Self-report questionnaires
• Questionnaires completed by significant others
• Behavioural tests
• Observational methods

Question 16

QUESTION MARK!

LEAD standard instead of gold standard?
prodedural validity

Answer 16

Look up, or ask someone! not sure!

Question 17

Sensitivity?

Example of when this might be particularly helpful?

Answer 17

the ability of a test to predict true positives.

(Probability that a person with a clinical diagnosis will receive the same diagnostic interview diagnosis)

Used for medical tests e.g. high sensitivity in a test needed when the cost of not finding cases is high e.g. test of cancer.

Question 18

Specificity?

Answer 18

Ability of test to exclude a true negative. If a test has
high specifiity its good at classifying those who dont have the dignosis. Needed when the cost of false posiitves is high.

(Probability that a person without a clinical diagnosis will not receive that diagnosis via the diagnostic interview)

Question 19

Positive predictive values?

Answer 19

Proportion of people with positive who are true positive. represents presence of disease.

Probability that a person with a diagnostic interview diagnosis is truly 􏰂ill􏰃

Question 20

Negative predictive value?

Answer 20

proportion of negative results that are true negatives. Represents the absence of disease.

Probability that a person without a diagnostic interview diagnosis is truly 􏰂well􏰃

Question 21

What is Cohen’s kappa coefficient?

Answer 21

Can use if for both validity and reliability.
a statistic which measures inter-rater agreement for qualitative (categorical) items. κ takes into account the possibility of the agreement occurring by chance.

Question 22

Interpretation of kappa

What would an agreement of these correlations be?
.65
.56
.3
0

Answer 22

≥ .75 - excellent agreement
 .6 to .74 – good agreement
.4 to .59 – fair agreement
less than .4 – poor agreement 
0 – agreement at chance level

Question 23

Distinguish between global and specific questionnaires.

Answer 23

Global measures
• Assess multiple symptoms
• Provide an overall level of severity of psychopathology
(tend to be used in initial phases on contact with patient. Might be used for initial screening). Very general.

Specific measures
• Assess a limited set of symptoms
• Provide measures of the level of severity of a specified problem
(more commonly used in treatment process. And monitoring progress of client)

Question 24

The Brief Symptom Inventory is an example of a global questionnaire.
What are some characteristics?

(what, no. of items, scale?, Relibability and validity adequate?, how many symptoms does it test)

Answer 24

Designed to reflect psychological symptom patterns of patients and non-
patients
• 53 items describing psychiatric symptoms
• Items are rated on a five-point scale indicating the level of distress each symptom has caused over the past 7 days
• 0=Not at all, 1=A little bit, 2=Moderately, 3=Quite a bit, 4=Extremely
• Adequate reliability (internal consistency and test-retest reliability) and validity (construct)
• tests 9 primary symptom dimensions

Question 25

Brief Symptom Inventory

What are the three global indices of distress in the Brief Symptom Inventory?

LIST ONLY

Answer 25

• GSI – Global Severity Index
• PSDI – Positive Symptom Distress Index
• PST – Positive Symptom Total

Question 26

Brief Symptom Inventory:

Describe what the Global Severity index (GSI ) is.

Answer 26

The Global Severity Index (GSI) is designed to help quantify a patient’s severity-of-illness and provides a single composite score for measuring the outcome of a treatment program based on reducing symptom severity.

Question 27

Brief Symptom Inventory:

Describe what Positive Symptom Distress Index (PSDI) is

Answer 27

measure of symptom intensity

Question 28

Brief Symptom Inventory:

Describe what Positive Symptom Total is as an Index.

Answer 28

measure of symptom breadth.

Question 29

An example of a specific questionnaire measure would be

Answer 29

Beck Anxiety Inventory

Question 30

Characteristics of the Beck Anxiety Inventory.

(no of items, purpose (what disorder does it focus on), tries to distinguish what, scale

Answer 30

• 21-item measure developed to assess the severity of anxiety symptoms in clinical populations
• Aims to reliably distinguish anxiety from depression
• Ratings of how much respondents have been bothered by each of the symptoms over the past week on a 4-point scale
• 0 - not at all to 3 severely, I could barely stand it
• Good reliability (internal consistency and test-retest) and validity (construct)

Question 31

What are behavioural tests used for?

What is an example of one.

Answer 31

• Most commonly used in assessment of anxiety disorders
• An example is the Behavioural Avoidance Test (developed for specific phobias)

(Used to elicit anxiety in a realistic situation.
get an idea of catastrophic or unrealistic thinking.
E.g. how high up a ladder someone with fear of heights can go)

Question 32

Behavioural tests measures three things:

e.g. the behavioural avoidance test (for phobias)

Answer 32

behaviours, cognitions and physiological responses.

Question 33

More examples of Behavioural tests ie. the behavioural avoidance test, and what it would measure.

Answer 33

Specific phobia-Client’s distance from feared object
Agoraphobia-Walking distance from home
Social Anxiety Disorder-Delivering an impromptu speech
OCD-Touching “contaminated” objects

Question 34

What is the usual method of testing client-outcome? ie how well theyve improved?

What is progress monitoring?

Answer 34

administer a test at the beginning of
treatment (pre-treatment) and again at the end of treatment !

OR
It is also common to give brief measures throughout treatment! = progress monitoring

Question 35

Two criteria are necessary for an individual to demonstrate a clinically significant change….

Answer 35

improvement:
• the dependent measure must show a reliable change that is larger than the
measurement error of the instrument (Reliable Change Index)

recovery:
• after treatment, the individual’s score on the dependent measure is more likely to be drawn from the distribution of a functional than a dysfunctional population

Question 36

If RC (Reliable change index) is above ……. then the patient’s change is reliable.

Answer 36

> 1.96 :) = reliable change from pre treatment to post.

Question 37

There are 3 ways to operationalise ‘normal functioning’
or in other words, conclude normal functioning. Do you know them?

Hint=they all refer to means or standard deviations.

They all mean the same shit. Depends on the data you have e.g. if you only have data on functional means, then could only use A.

Answer 37

a. post-treatment score should fall outside the range of the dysfunctional
population, where range is 2 sd’s beyond the mean
b. post-treatment score should fall within the range of the functional population (within 2 sd’s of the mean)
c. post-treatment score is closer to the mean of the functional than of the dysfunctional population

Question 38

Many definitions of a patient’s change that is clinically significant involve the idea that the patient ‘returns to normal functioning’. Well yes.. but we also want..

Answer 38

them to stay reliably normative. We want our confidence intervals to be below the normative line! :)

Question 39

What does statistical significance mean? and why do we prefer to use clinical significance as a term to conclude change in the patient?

Answer 39

The comparing of GROUP means and if its above .05 then its significant.

because we dont have a GROUP. And while a groups change may be signficant, it may not be signficant for the individual! Not everyone in the group improves!

Clinical sig looks at individual progress, and meaningful change for the individual! So inspiring. Be kind to one another.