Ch. 4, Clinical Assessment

Question 1

Reliability/ test-retest reliability/ inter-rater reliability

Answer 1

reproduction of the study over time; measure of consistency
Test-retest reliability: produces the same results every time on a test (IQ test)
Inter-rater reliability: reflects the degree to which clinicians agree on the diagnosis

Question 2

Validity/ standardization/ T score distribution

Answer 2

measures what it is supposed to measure
validity= presupposes reliability bc it needs to measure what its supposed to in order to be reliable
Standardization: process by which a psychology test is administered, scored, and interpreted
T score distribution: comparing an individual’s test score on a distribution of test scores from a large normative population

Question 3

Basic elements of assessment

Answer 3

(1) Assessment is ongoing: continue to evaluate progress
(2) Pretreatment assessment establishes the baseline for various psychological functions so that the effects of treatment can be measured

Question 4

Presenting problem

Answer 4

major symptoms and behavior the client is experiencing; has to focus on the individual’s personality, self etc not just the problem
HOW CLINICIANS GO ABOUT TREATMENT DEPENDS ON THEIR ORIENTATION

Question 5

Cultural competence/ ethics code of the APA

Answer 5

informed of the issues involved in multicultural assessment
APA: american psychological association recommends that psychologists consider various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, linguistic, and cultural differences that might affect their judgment or reduce the accuracy of their response

Question 6

Trust with clients

Answer 6

clinical assessment situation, this means that a client must feel that the testing will help the practitioner gain a more complete understanding of her or his problems and must understand how the tests will be used and how the psychologist will incorporate them into the clinical evaluation=The clinician should explain what will happen during assessment and how the information gathered will help provide a clearer picture of the problems the client is facing.

Question 7

Test feedback/clients

Answer 7

when clients are given test feedback they tend to improve bc they have gained a more informed perspective on their problems

Question 8

Clinical Interview vs structured interview vs semi-structured interviews

Answer 8

clinical interviews: global approach, central element of the assessment process, involves face-to-face interaction in which a clinician obtains info about various aspects of client’s situation, behavior, personality, CAN BE OPEN OR MORE DETAILED, MUCH LESS RELIABLE
structured assessment interview: predetermined format, much more closed, be used by people who aren’t clinciians bc its already been standardized, useful in epidemiological studies where lots of interviwers are needed, and everyone is asked the same questions: BETTER/MAXIMIZED RELIABILITY
semi-structured: ask specific set of questions in specific way; depending on the answer, clinicians will ask their own follow up questions to obtain more information (ONLY USED BY TRAINED PROFESSIONALS, LONGER TO COMPLETE,

Question 9

Unstructured assessment interviews

Answer 9

subjective, don’t follow any predetermined questions, general statements, take less time

Question 10

Most traditional and most useful assessment tools that a clinician has available

Answer 10

direct observation of a client’s characteristic behaviour: main purpose is to learn more about a person’s psychological functioning by seeing their habits etc

Question 11

Analogue situations/ role playing

Answer 11

when a more controlled behavioural setting is used for conducting observations which are designed to give info about the person’s adaptive strategies
may use role playing, event reenactment, family interaction assignments, etc

Question 12

Self-monitoring/ rating scales

Answer 12

self-observation and objective reporting of behaviours, thoughts and feelings; many clinicians will ask them to do this
Rating scales: help to organize info and encourage reliability and objectivity; formal structure of the scale is likely to keep observer inferences to a minimum
Most useful ones = allow rater to indicate not just the presence or absence of a trait/behaviour, but also its prominence/degree

Question 13

Most widely used instruments for assessing the prescence and severity of psychiatric symptoms in clinical settings/psychiatric research

Answer 13

Brief Psychiatric Rating Scale, BPRS
originally developed as a 16 item measure
now includes 24 items: can assess anxiety, depression, emotional withdrawal, guilt feeling, hostility, suspiciousness, grandiosity, and usual thought patterns= CAN BE PROBED FOR USING QUESTIONS FROM A SEMI STRUCTURED INTERVIEW
*NOT USED FOR MAKING TREATMENT OR DIAGNOSTIC DECISIONS

Question 14

Indirect vs direct means of assessing psychological characteristics; projective vs objective tests

Answer 14

direct: interviews/behavioural observation
Indirect: psychological tests

Question 15

Weschler Intelligence Scale for Children Revised (WISC-IV) and Stanford Binet Intelligence Scale and Wechsler Adult Intelligence Scale Revised (WAIS-IV)

Answer 15

most widely used intelligence tests
weschler adult is most common intelligence test for adults, incluides verbal and performance material and consists of 15 subtests
usually only used in clinical settings where intellectual or brain damage is thought to be central to the patient’s problem

Question 16

WAIS-IV vocabulary and digit span

Answer 16

vocab: verbal, This subtest consists of a list of words to define that are presented orally to the individual. This task is designed to evaluate knowledge of vocabulary, which has been shown to be highly related to general intelligence.
digit span:performance, : In this test of short-term memory, a sequence of numbers is administered orally. The individual is asked to repeat the digits in the order administered. Another task in this subtest involves the individual remembering the numbers, holding them in memory, and reversing the order sequence—that is, the individual is instructed to say them backward

Question 17

Projective personality tests (3 types)

Answer 17

unstructured because they relay on various ambigous stimuli and people must interpret them
Rorschach Inkblot Test: Hermann Rorschach, interpret inkblots; UNRELIABLE, SUBJECTIVE, OVERPATHOLOGIZES THE PATIENT NO VALIDITY, still used as one of the most frequent in personality assessment?
Thematic Apperception Test (TAT): Morgan and Murray, used in clinical and personality, uses a series of pictures, subject has toi make up stories about the pictures (scoring mechanisms have been adopted to asess p[erson’s expression of needs, person’s perception of reality, and the person’s fantasies)
Sentence Completion test: beginnings of sentences to then complete, free association method,

Question 18

Strengths/limitations of projective tests

Answer 18

strengths: unstructured nature and focus on unique aspects of personality
weaknesses: same, interpretation is subjective, unreliable, and difficult to validate, wastes time, needs advanced skills

Question 19

Objective personality tests (

Answer 19

structured, controlled, reliable, precise
1. NEO-PI: Neuroticism, extroversion, openness, personality inventory, provides major dimensions of personality and is used for evaluating personality factors in normal range populations
2. SNAP: schedule for nonadaptive and adaptive personality: asess clinical AND pathological
3. MMPI: Minnesota Multiphasic personality inventory

Question 20

MMPI and MMPI-2 and MMPI-A, most typical use for it

Answer 20

Hathaway and McKinley, most widely uised personality test for clinical and forensic assessment: most typical use is for diagnostic standards and for parthology research in the US
MMPI-2: adults
MMPI-A: adolescence
self-report questionnaire
responses are plotted on standard MMPI profile form

Question 21

Empirical keying

Answer 21

method of selecting scorable items on test that hold up, no subjective, compared normal to pathology population to see if there is differences bc there should be

Question 22

MMPI validity scales for lying/faking

Answer 22

scales that detect over exaggeration and that detect possible faking of symptoms

Question 23

advantages/limitations of objective personality tests

Answer 23

cost effective, reliable, objective
can be scored and intepreted using technology
Criticisms: maybe too mechanistic toi portray the complexity of human behavior, patients who struggle with reading comp or are illiterate cannot take them, individual must cooperate and not try to produce a particular impression of themselves (but there are scales in the MMPI-2 that deal with this issue), rely on retrospective memory

Question 24

Biosensors/daily measures

Answer 24

people are likely to report higher depressive symptoms when asked on a daily basis aboiut them/bc they remember better
best way of ecological validity: passively collect info about a person’s daily life that can help to better understand their psychological functioning

Question 25

Physical examination

Answer 25

when physical symptoms are part of the presenting clinical picture, a referral for a medical evaluation is recommended

Question 26

Neuropsychological assessment

Answer 26

use of various test to measure a person’s cognitive, percpetual and motor performance can inform treatment recommendations
involve use of a test battery: variety of different tests will be used, with each test assessing different areas of ability
these tests are performance based and standardized: person’s performance is being compared to normative standards of a reference group

Question 27

Halstead-Reitan neuropsychological test battery

Answer 27

composed of several tests and variables from which an index of impairement is computed, provides specific info about a subject’s functioning in several skill areas, CAN BE VERY EXPENSIVE AND TIME CONSUMING

Question 28

Trail Making Test

Answer 28

involves visual attention and task switching, in Trails A, patient has to connect the numbers as quickly as possible
in Trails B: the task requires alternating between numbers and letters

Question 29

EEG

Answer 29

electroencephalogram
uses electrrodes all over scalp, pick up electrical current, non invasive, temporal resolution (real time feedback) is very good, important for diagnosing epilepsy as seizures appear as spiky-looking waves

Question 30

CT scan

Answer 30

computed tomography, X ray images taken from many many angles give a holistic 3D picture, radiation risks, good for hard tissue, less good for soft tissue
Contrast Agents: used to improve the image quality
can also detect bone injuries, cancers, organm problems
no temporal

Question 31

MRI/ sMRI

Answer 31

magnetic resonence imaging
noninvasive, no radiation, uses magnet of 3 tesla power, 46,000 times stronger than the earth’s magnetic field, causes hydrogen atoms (which are magnetic) to move
people who are claustrophobic, obese, can’t sit still or have metal in their bodies cannot, very good spatial,
sMRI: structural MRI, informs us about brain structures

Question 32

Schizophrenia and brain volume using sMRI

Answer 32

reduced volume in schizophrenia patients

Question 33

fMRI

Answer 33

neuronal activity, working brain, oxygenated and deoxygenated blood have diff magnetic properties, poor temporal resolution so not very fast at picking up activity, cannot just localize an area for delusions: it is about functional connectivity

Question 34

fMRI nd major depression vs not

Answer 34

depressed people: reduced activation compared to normal in ventral striatum, brain region involved in reward, after recieving rewarding stimuli

Question 35

PET

Answer 35

positron emission tomography
radioactive substance injected in bloodstream, expensive, expertise, functional technique, isotopes decay raidly, poor temporal, good for cancer and dementia, detecting activity at diff NT receptor sites,

Question 36

Cyclotron

Answer 36

radioactive isotopes are produced here bc of short half lives and decay

Question 37

Best neuroimaging method

Answer 37

MRI because it has high spatial resolution and does not require tracers

Question 38

Factors to evaluate when producing test results

Answer 38

Potential cultural bias of the instrument or the clinician: Some psychological tests may not elicit valid information for a patient from a minority group
Theoretical orientation of the clinician: Assessment is inevitably influenced by a clinician’s assumptions, perceptions, and theoretical orientation
Underemphasis on the external situation: Many clinicians overemphasize personality traits as the cause of patients’ problems without paying enough attention to the possible role of stressors and other circumstances in the patients’ life situations.
Insufficient validation: Some psychological assessment procedures in use today have not been sufficiently validated.
Inaccurate data or premature evaluation: There is always the possibility that some assessment data—and any diagnostic label or treatment based on them—may be inaccurate or that the team leader (usually a psychiatrist) might choose to ignore test data in favor of other information

Question 39

MMPI-2 and cultural differences

Answer 39

does hold up cross culturally

Question 40

Cognitive prototype

Answer 40

essential features of something (dogness)

Question 41

Classification

Answer 41

attempt to delineate meaningful subvarieities of maladaptive behavio; first step toward introducing order into the discussion of the nature, causes and treatments of behavior

Question 42

Categorical approach to classification

Answer 42

the categorical approach seeks to classify behavior into distinct categories. Fundamental to this approach is the idea that human behavior can be sorted into the categories of “healthy” and “disordered,” as is done in medicine with various diseases.
-Another assumption is that within the broad class of disordered behavior there are non-overlapping sub-classes or types of disorder that have a high degree of within-class similarity in both symptoms displayed and the underlying organization of the disorder identified. This is the approach that is used in the DSM.

Question 43

Problems with the categorical approach

Answer 43

-cannot always be certain we are identifying and classifying different conditions correctly
-how broad or narrow categories should be
-Comorbidity: the classification system should provide us with categoriews that represent distinct conditions with little overlap, but high levels of comorbidity suggest that we may be giivng multiple labels to different variants of the same underlying conditions
-doesn’t consider severity: more of a yes or no approach
-

Question 44

RDoc/intermediate constructs/examples

Answer 44

Research Domain Criteria
Represents a new effort to provide a template for psycopathology research
RDoC takes a transdiagnostic perspective, opposite the DSM: doesn’;t focus on traditional diagnostic categories and provides biological explanations for intermediate psychological constructs that are thought to be relevant to psychopathology
intermediate psychological constructs: An example of an intermediate psychological construct might be reward motivation. When excessive, this might contribute to gambling, or substance abuse, or binge eating. In contrast, low reward motivation might play a role in anhedonia (lack of pleasure), which is often found in people who are depressed or who have schizophrenia.
-regards mental disorders as dysfunctions in psychobiological circuitry
-prduces matrix of increasing complexity: the rows show the various domains/constructs thought to be relevant to understanding apsects of pscyopathology 😍

Question 45

criticisms of RDoc

Answer 45

less emphasis on psyosocial variables, RDoc may be prematurely reified and constrain new research on other topics
will not replace DSM: but RDoC is an important and needed effort to increase our understanding of neural circuitry as it relates to key elements of psychopathology

Question 46

Dimensional approach

Answer 46

assumed that a person’s typical behavior is the product of the differing strengths or intensities of definable dimensions such as mood, emotionaly stability, etc
preserves info about individual variability, considering that disorders might be a spectrum adds complexity to any communication about how that person behaves/functions
-even still, there is a tendency to use cutoff marks as to whether a person has or doesn’t have a disorder: but these cut points can be used to define mild/moderate or severe levels of dysfunction
APPEARS IN A SPECIAL SECTION IN THE DSM 5

Question 47

Prototypal Approach

Answer 47

conceptual entity that represents the ‘perfect case’ or ‘theoretically ideal’ case
-provides a standard against which individuals can be compared in order to assign them to a particular category.
-fits the way people actually think: rate the overall sim,alrity/match between a patient and the prototype
-predict adaptive functioning better than the categorical dsm diagnoses do
-we can uyse data to create groupings of clinical features that tend to aggregate together

Question 48

ICD-11 diagnostic system

Answer 48

uses clinical prototypes

Question 49

symptom vs sign

Answer 49

symptom: refers to the patient’s subjective description about what is wrong
signs: objective and visible indicators of a probem

Question 50

DSM 1980 revision importance

Answer 50

. Standardized diagnostic criteria were provided, and decision rules were introduced for all diagnoses. This was designed to remove, as much as possible, the element of subjective judgment from the diagnostic process. In a typical case, a specific number of signs or symptoms from a designated list had to be present before a diagnosis could properly be assigned.

Question 51

1980 DSM atheoretical design

Answer 51

The new DSM was also atheoretical (with the exception of Post-traumatic Stress Disorder, where it was accepted that the condition was caused by a traumatic stressor). Apart from this, no assumptions were made about etiology, and concepts tied to psychoanalysis or other theoretical orientations were largely removed. This made the new system much more acceptable to a wide range of clinical practitioners and clinical researchers

Question 52

Controversy in the DSM 5

Answer 52

the thresholds for several disorders were relaxed. Combined with the increasing number of diagnoses, this has led to concerns that normal behavior is becoming over-medicalized.

Question 53

Cultural Formulation Interview (CFI)

Answer 53

contains 16 questions that the practitioner can use to obtain information about the potential impact the client’s culture can have on mental health care. The interview questions inquire about patients’ perspectives on their present problems, how they perceive the influence of others regarding their problems, and ways in which their cultural background may impact their adjustment.

Question 54

Difference between the terms patient and client

Answer 54

patient: associated with medical sicknesss and passive stance waiting for cure
client: implies greater participation on the individuals part

Question 55

Most prevalent problem with earlier diagnostic manuals

Answer 55

personality disorders were classified as categorical rather than dimensional

Question 56

PTSD in earlier diagnostic manuals vs now

Answer 56

earlier required that a person witness a traumatic event, then it was developed to include indirect
DSM-5: now only includes direct again

Question 57

Bereaved people vs depressed in DSM -5

Answer 57

bc of unclear diagnoses, it could diagnosis people experience grief as having depression, result in the medicalization of emotion and immediate medication for it