Chap 3: Assessment, classification and diagnoses

Question 1

What is clinical assessment?

Answer 1

The process of gathering information about a person and their environment to make decisions about the nature, status and treatment of their psychological problems

Question 2

What are the two goals of clinical assessments? what are the five elements of a diagnoses?

Answer 2

Screening to identify psychological problems or predict the risk for future problems (good tools have high sensitivity and specificity and low false posi/negi)
Diagnoses (identification of illness) and differential diagnoses
Elements:
1. Symptoms
2. Severity of symptoms
3. Pattern of symptoms over time
4. Patient strengths and weaknesses
5. Results from assessments and other tests

Question 3

What are the three properties of assessment instruments?

Answer 3

Standardization
- Normative comparisons: comparing person’s score to normal curve + standard deviations (+2 = 5% of pop = meaningfully different)
- Self-referent comparisons: compared to old test results
Reliability
- Test-retest reliability: how well a test produces similar results over time when given to the same patient
- Interrater agreement
Validity
- Construct, criterion, concurrent, predictive

Question 4

What are the five types of clinical assessment? Briefly describe what they entail

Answer 4

Clinical interviews - gather information and make judgements related to assessment goals (unstructured or structured)

Psychological tests - designed to determine cognitive, emotional, personality, and behavioural factors in psychopathological functioning

Behavioral - attempt to understand behaviour within the context of learning (ex: self-monitoring or behavioural interview)

Psychosociological - measure brain and nervous system activity (ex: biofeedback or electrocardiogram)

Biological - rarely used as primary method of diagnoses, looks at structures of the brain (ex: MRI or fMRI)

Question 5

What are the 5 kinds of psychological tests? Define the ones that aren’t self explanatory

Answer 5

1. Personality
2. Projective (people asked to respond to ambiguous stimuli)
3. Neuropsychological (detect impairment in cognitive function, measures memory, attention and concentration, motor skills, perception, abstraction, and learning abilities)
4. Cognitive/psychological functioning (can be general (MBTI or GHQ) or specific (BPRS or BDI))
5. Intelligence

Question 6

What are the advantages and limitations of the classification system?

Answer 6

Advantages

• Standardizes diagnosis and treatment
• Provides basis for communication
• Research guidance
• Therapeutic guidance

Limitations

• Different symptoms manifestation
• No focus on etiology
• Different responses to treatment
• Loss of information about the individual
• DSM reflects limited knowledge of an era and lists too many disorders

Question 7

When is diagnostic system harmful? (unintended consequences)

Answer 7

Stereotypes and labels
Premature or inaccurate assumptions by clinicians
Prevention of thorough evaluation or comprehensive treatment plan
Self-fulfilling prophecies
Stigma
Over-medicalization

Question 8

What is a dimensional system of classification? What features support this approach?
Benefits and limitations?

Answer 8

Conceptualizes psychiatric illness as dimensions of functioning rather than discrete clinical conditions
Features that support:
- High frequency of comorbidity
- Within category variability

Benefits:
Richer description of patient difficulties 
Allows for subthreshold diagnosis 
Accounts for heterogeneity 
Helpful for disorders with range of severity 
Results in less comorbidity 
Limitations: 
Questions of clinical utility 
Complex to communicate 
No consensus on a dimensional theory