Assessment and Diagnosis Flashcards
Why do we do an initial assessment and usually assign a diagnosis?
- determine main symptoms/problems
- select appropriate treatment
- formulate treatment goals
- gather baseline data for later comparisons
- help us communicate with other providers
- to permit insurance reimbursement
Psychological Assessment
- what is the client’s presenting problems?
- may use psychological tests, observations, interviews
- summarize clients symptoms and problems
- ongoing process
- more of a narrative
Clinical Diagnosis
- under what “label” does the client best fit?
- use results of the assessment to arrive at a summary classification
- DSM-5 (US) or ICD-10 (rest of world)
- usually needs to be set at the onset of treatment, but may change over time
Important Issues to Consider
- what is the client’s behavior like in different settings? is it consistent?
- what personality characteristics stand out?
- what does the client’s social context look like?
- Am I assessing the client in a culturally sensitive manner?
- How does my professional orientation impact my assessment?
- Are my assessment instruments reliable? valid? standardized?
- Does my client trust me?
Physical Exam
=especially important for certain disorders
- depression, anxiety: check thyroid
- bipolar: check for substance abuse
- major neurocognitive disorders: may be B12 deficiency
Neurological Exam
=electroencephalograms (EEG)
=CT scans, MRI scans
=PET scans
EEG
- record voltage changes occurring at the scalp
- reflect activity in brain underneath the scalp
CT scans, MRI scans
- very detailed snapshots
- looks at anatomy
- can show brain changes in relation to psychiatric disorders, ex schizophrenia has enlargement of some areas
PET scans
- appraisal of how an organ is functioning
- provides metabolic portraits by tracking compounds such as glucose as the are metabolized
- useful in Alzheimer’s research
- used to locate location of stroke or tumor
fMRI scans
- functional MRI
- measure changes in local oxygenation
- measure activity of brain areas based on oxygen levels
Neuropsychological Examination
- use of various testing devices to measure a person’s cognitive, perceptual and motor performance as clues to the extent and location of brain damage
- doc can use standard group of tests or choose which for that individual
- Halstead-Reitan battery for adults
Psychosocial Assessment
- may be structured or unstructured
- may include use of role plays, self monitoring, and or rating scales
Adv and Disadv of structured psychosocial assessment
Adv -easier to compare, a form to follow
DisAdv -may feel like rapid fire questioning
Symptoms vs Signs
Symptoms: why they came to you, what they are saying
Signs: what you see going on, ex constant fidgeting
Psychological Tests
- standardized sets of procedures/tasks
- obtain samples of behavior
- responses are compared to test norms
- values depend on skill of clinician
- more common in research and hospital/clinic settings
Intelligence Testing
- Wechsler IQ Score
- WAIS testing: adult version
- comprehension, arithmetic, information
Personality Testing
- can be projective or objective
- contain very extensive validity scales
Projective (explanation, strengths, weaknesses)
-ambiguous, stimulus, picture
-ex: Rorschach- comes from psychodynamic framework
=Strengths:
-qualitative data, ice breakers
=Weaknesses:
-answers can be influenced by tester’s attitude, setting
-subjective scoring
-validity? reliability?
Objective (explanation, strengths, weaknesses)
-restricted responses, not ambiguous stimuli
-ex: Likert Scale, MMPI 2
=Strengths:
-economical
-objective scoring
-valid, reliable
=Weaknesses
-one score
-self knowledge
-faking
-little info on dynamics underlying behavior
MMPI 2
=567 True False Questions =Measures 10 Clinical Scales -rough assessment of disorders -intrapersonal relations -behavioral problems -treatment possibilities -characteristics =very strong validity measures
About Validity Scores for MMPI 2
- Measures 9 validity scales
- used to determine malingering or pretending to be healthier than you are
- very hard to malinger on this test
About Clinical Scales for MMPI 2
- 10 scales
- each associated with a personality characteristic that can be seen in disorders
- elevated scores on different combinations of scales suggest different disorders
- no one elevated scale is enough on its own to make a diagnosis
Validity Scales of MMPI 2: 1-4
- Cannot say score - measures total number of unanswered items
- Infrequency scale (F) - measures false or exaggerated claims in first half of booklet, detects random responding
- Infrequency scale (FB) - false or exaggerated claims on items toward end of booklet
- Infrequency scale (Fp) - exaggerate problems among psychiatric patients
Validity Scales of MMP2: 5-9
- Lie scale (L) - claim excessive virtue
- Defensiveness scale (K) - see oneself in an unrealistically positive way
- Superlative Self-Presentation scale (S) - present in a highly positive manner
- Response Inconsistency scale (VRIN) - endorse items in an inconsistent/random manner
- Response Inconsistency scale (TRIN) - endorse items in an inconsistently true or false manner
Clinical Scales of MMPI2: 1-5
- Hypochondriases (Hs) - excessive physical complaints
- Depression (D) - symptomatic depression
- Hysteria (Hy) - ex “rose colored glasses”, tendency for physical problems under stress
- Psychopathic deviate (Pd) - antisocial
- Masculinity-femininity (Mf) -gender role reversal
Clinical Scales of MMPI2: 6-10
- Paranoia (Pa) - suspicious, paranoid ideation
- Psychasthenia (Pt) - anxiety and obsessive worrying behavior
- Schizophrenia (Sc) - peculiarities in thinking, feeling, and social behavior
- Hypomania (Ma) - unrealistically elated mood state and tendencies to yield to impulses
- Social Introversion (Si) - social anxiety, withdrawal, over control
Always consider….
- why someone may be responding the way they did
- the effects of coaching
Diagnosis
- 3 approaches to classifying abnormal behavior
1. categorical
2. dimensional
3. prototypical
Categorical Approach
- either normal or abnormal
- can be a category within abnormal, but only one
- no overlap, no comorbidity
Dimensional Approach
- everyone is somewhere on the scales (depression, anxiety, etc)
- where do you fall? how much of a symptom set?
Prototypical Approach
- how do you compare to a prototype of the disorder?
- a prototype is a very typical presentation of the disorder
Classification systems
=ICD-10: WHO, most of the world
=DSM-5: APA, US
-since the DSM-3, has given an exact recipe for the disorder, before it was more prototypical
