Chapter 3

Question 1

Process of clinical assessment is like?

Answer 1

Has been likened to a funnel… The clinician begins by collecting a lot of information across a broad range of the individual’s functioning to determine where the source of the problem may lie. After getting a preliminary sense of the overall functioning of the person, the clinician narrows the focus by ruling out problems in some areas and concentrating on areas that seem most relevant.

Question 2

Reliability

Answer 2

Degree to which a measurement is consistent—for example, over time or among different raters.

Question 3

Validity

Answer 3

Degree to which a technique actually measures what it purports to measure.

Question 4

What are the types of validity?

Answer 4

Comparing the results of one assessment measure with the results of others that are better known allows you to begin to determine the validity of the first measure. This comparison is called concurrent validity.

Predictive validity is how well your assessment tells you what will happen in the future.

Question 5

Standardization

Answer 5

Process of establishing specific norms and requirements for a measurement technique to ensure it is used consistently across measurement occasions. This includes instructions for administering the measure, evaluating its findings, and comparing these to data for large numbers of people.

Question 6

The clinical interview

Answer 6

The interview gathers information on current and past behaviour, attitudes, and emotions, as well as a detailed history of the individual’s life in general and of the presenting problem. Clinicians determine when the specific problem first started and identify other events (e.g., life stress, trauma, physical illness) that might have occurred about the same time. In addition, most clinicians gather at least some information on the patient’s current and past interpersonal and social history, including family makeup (e.g., marital status, number of children, student currently living with parents), and on the individual’s upbringing. Information on sexual development, religious attitudes (current and past), relevant cultural concerns (such as stress induced by discrimination), and educational history are also routinely collected.

Question 7

Mental status exam

Answer 7

Relatively coarse preliminary test of a client’s judgment, orientation to time and place, and emotional and mental state; typically conducted during an initial interview

Question 8

Appearance and behaviour of a mental status exam

Answer 8

The clinician notes any overt physical behaviours, such as Frank’s leg twitch, as well as the individual’s dress, general appearance, posture, and facial expression.

Question 9

Thought processes of a mental status exam

Answer 9

When clinicians listen to a patient talk, they’re getting a good idea of that person’s thought processes. They might look for several things here. For example, does the person talk really fast or really slowly? Does the patient make sense when he or she talks or are ideas presented with no apparent connection? In addition to rate or flow and continuity of speech, what about the content? Is there any evidence of delusions (distorted views of reality)? The individual might also have ideas of reference, where everything everyone else does somehow relates back to him

Question 10

Mood and affect

Answer 10

Mood is the predominant feeling state of the individual, as we noted in Chapter 2. Does the person appear to be down in the dumps or continually elated? Does she or he talk in a depressed or hopeless fashion? Are there times when the depression seems to go away? Affect, by contrast, refers to the feeling state that accompanies what we say at a given time.

Question 11

Intellectual functioning

Answer 11

Intellectual functioning. Clinicians make a rough estimate of others’ intellectual functioning just by talking to them. Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors (as most of us do much of the time)? How is the person’s memory? We usually make some gross or rough estimate of intelligence that is noticeable only if it deviates from normal, such as concluding the person is above or below average intelligence.

Question 12

Sensorium mental status exam

Answer 12

Intellectual functioning. Clinicians make a rough estimate of others’ intellectual functioning just by talking to them. Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors (as most of us do much of the time)? How is the person’s memory? We usually make some gross or rough estimate of intelligence that is noticeable only if it deviates from normal, such as concluding the person is above or below average intelligence.

Question 13

Semi-structured interviews

Answer 13

Semistructured interviews are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner, so clinicians can be sure they have inquired about the most important aspects of particular disorders. Clinicians may also depart from set questions to follow up on specific issues—thus the label “semistructured.” Because the wording and sequencing of questions has been carefully worked out over many years, the clinician can feel confident that a semistructured interview will accomplish its purpose. The disadvantage, of course, is that it robs the interview of some of the spontaneous quality of two people talking about a problem. Also, if applied too rigidly, this type of interview may inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked.

Question 13

Are physical exams required before making a diagnoses?

Answer 13

If the patient presenting with psychological problems has not had a physical exam in the past year, a clinician might recommend one, with particular attention to the medical conditions sometimes associated with the specific psychological problem. Many problems presenting as disorders of behaviour, cognition, or mood may, on careful physical examination, have a clear relationship to a temporary toxic state. This toxic state could be caused by bad food, the wrong amount or type of medicine, or the onset of a medical condition (hypothyroidism is a good example).

Question 14

How to determine if problems associated with the disorder are co-exsisting or casual?

Answer 14

If a current medical condition or substance abuse situation exists, the clinician must ascertain whether it is merely co-existing or causal, usually by looking at the onset of the problem. If a patient has experienced severe bouts of depression for the past five years but within the past year also developed hypothyroid problems or began taking a sedative drug, then we would not conclude the depression was caused by the medical or drug condition.

Question 15

Behavioural Assessment

Answer 15

Measuring, observing, and systematically evaluating (rather than inferring) the client’s thoughts, feelings, and behaviour in the actual problem situation or context. goes past the mental status exam by Measuring, observing, and systematically evaluating (rather than inferring) the client’s thoughts, feelings, and behaviour in the actual problem situation or context.)

Question 16

What is targeted in behavioural assessment?

Answer 16

In behavioural assessment, target behaviours are identified and observed with the goal of determining the factors that seem to influence those behaviours. It may seem easy to identify what is bothering a particular person (i.e., the target behaviour), but even this aspect of assessment can be challenging.

Question 17

What are the ABC’s of intervention?

Answer 17

his mother asking him to put his glass in the sink (antecedent),

the boy throwing the glass (behaviour), and

his mother’s lack of response (consequence).

Question 18

Informal and formal observation

Answer 18

• informal observation. During the home visit, the clinician took rough notes about what occurred. Later, in his office, he elaborated on the notes. A problem with this type of observation is that it relies on the observer’s recollection and on his or her interpretation of the events.

-Formal observation involves identifying specific behaviours that are observable and measurable. For example, it would be difficult for two people to agree on what “having an attitude” looks like. A formal observation, however, clarifies this behaviour by specifying that this is “any time the boy does not comply with his mother’s reasonable requests.”

Question 19

Self-monitoring

Answer 19

Action by which clients observe and record their own behaviours as either an assessment of a problem and its change or a treatment procedure that makes them more aware of their responses. Also called self-observation.

Question 20

Behaviour rating scales

Answer 20

assessment tools before treatment and then periodically during treatment to assess changes in the person’s behaviour - Each symptom is rated on a seven-point scale from 0 (not present) to 6 (extremely severe). The rating scale screens for moderate to severe psychotic disorders and includes such items as somatic concern (preoccupation with physical health, fear of physical illness, hypochondriasis), guilt feelings (self-blame, shame, remorse for past behaviour), and grandiosity (exaggerated self-opinion, arrogance, conviction of unusual power or abilities.

Question 21

Projective tests

Answer 21

Psychoanalytically based measures that present ambiguous stimuli to clients on the assumption that their responses will reveal their unconscious conflicts. Such tests are inferential and lack high reliability and validity.

Question 22

Hermann Rorschach’s inkblot test

Answer 22

More than 80 years ago, a Swiss psychiatrist named Hermann Rorschach developed a series of inkblots, initially to study perceptual processes and then to diagnose psychological disorders. The Rorschach inkblot test is one of the early projective tests. In its current form, the test includes 10 inkblot pictures that serve as the ambiguous stimuli (see Figure 3.4). The examiner presents the inkblots one by one to the person being assessed, who responds by telling what he or she sees

Question 23

John Exner’s standardization version of the inkblot test (Comprehensive system)

Answer 23

Exner’s system of administering and scoring the Rorschach specifies how the cards should be presented, what the examiner should say, and how the responses should be recorded –> Varying these steps can lead to varying responses by the patient. Despite the attempts to bring standardization to the Rorschach test, its use remains controversial.

Question 24

Thematic Apperception Test (TAT)

Answer 24

The TAT consists of a series of 31 cards: 30 with pictures on them and 1 blank card, although only 20 cards are typically used during each administration (see Figure 3.5). Unlike the Rorschach, which involves asking for a straightforward description of what the test taker sees, the instructions for the TAT ask the person to tell a dramatic story about the picture. The tester presents the pictures and tells the client, “This is a test of imagination, one form of intelligence.” The person being assessed is asked to “let your imagination have its way, as in a myth, fairy story, or allegory”. (eveal their unconscious mental processes in their stories about the pictures.)

Question 25

Personality inventories

Answer 25

Self-report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them. In stark contrast to projective tests, which rely heavily on theory for an interpretation, the MMPI and similar inventories are based on an empirical approach, that is, the collection and evaluation of data. The administration of the MMPI is straightforward. The individual being assessed reads statements such as “I cry easily,” or “I believe I am being followed,” and answers either “true” or “false.”

Question 26

Four scales of the MMPI

Answer 26

four scales that determine the validity of each administration. For example, on the Lie scale (L), one statement is “I have never had a bad night’s sleep.” Answering “true” to this is an indication that the person may be falsifying answers to look good. The other scales are the F, or Infrequency scale, which measures false claims about psychological problems or determines whether the person is answering randomly; the K, or Defensiveness scale, which assesses whether the person sees himself or herself in unrealistically positive ways; and the Cannot Say scale, which simply measures the number of items the test taker did not answer.

Question 27

What is the MMPI?

Answer 27

The MMPI is one of the most extensively researched assessment instruments in psychology. The original standardization sample—the people who first responded to the statements and set the standard for answers—included many people from Minnesota who had no psychological disorders and several groups of people who had particular disorders. The more recent versions of this test, including the MMPI-2 and the MMPI-A, eliminate problems with the original version, problems partly resulting from the original selective sample of people and partly resulting from the wording of questions.

Question 28

What is the reliability of the MMPI?

Answer 28

The reliability of the MMPI is excellent when it is interpreted according to standardized procedures, and thousands of studies on the original MMPI attest to its validity with a range of psychological problems. But a word of caution is necessary here. Some research suggests that the information provided by the MMPI—although informative—does not necessarily change how clients are treated and may not improve their outcomes.

Question 29

PCL-R

Answer 29

Psychopathy can be assessed directly using the PCL-R, which was developed by forensic psychologist Robert Hare and his colleagues at the University of British Columbia. Since psychopaths are cunning and manipulative pathological liars, it is difficult to use self-report measures to assess psychopathy, especially in forensic settings (as a psychopath would likely lie and deny the existence of characteristics that would place him or her in a bad light). Hare developed the PCL-R as an instrument to assess the characteristics of psychopathy by using a semistructured interview with the client, along with material from institutional files (e.g., records from correctional institutions) or significant others. The PCL-R consists of a checklist of 20 characteristics, including pathological lying and superficial charm.

Question 30

Intelligence quotient

Answer 30

Score on an intelligence test, abbreviated IQ, estimating a person’s deviation from average test performance. Initially, IQ scores were calculated by using the child’s mental age. For example, a child who passed all the questions on the seven-year-old level and none of the questions on the eight-year-old level received a mental age of seven. This mental age was then divided by the child’s chronological age and multiplied by 100 to get the IQ score. There were problems, however, with using this type of formula for calculating an IQ score.

Question 31

Wechsler Test

Answer 31

The Wechsler tests include versions for adults (Wechsler Adult Intelligence Scale, WAIS-IV), for children (Wechsler Intelligence Scale for Children-Fifth Edition, WISC-5), and for young children (Wechsler Preschool and Primary Scale of Intelligence-Revised, WPPSI-IV). All these tests contain verbal scales (which measure vocabulary, knowledge of facts, short-term memory, and verbal reasoning skills) and performance scales (which assess psychomotor abilities, nonverbal reasoning, and ability to learn new relationships).

In both American and Canadian samples, the adult version of this intelligence test—the WAIS-III—has been shown to tap four distinct intellectual abilities: verbal comprehension, perceptual organization, processing speed, and working memory

Question 32

Neuropsychological testing

Answer 32

Assessment of brain and nervous system functioning by testing an individual’s performance on behavioural tasks.

Question 33

The bender Visual Motor Gesalt test

Answer 33

A child is given a series of cards on which are drawn various lines and shapes. The task is for the child to copy what is drawn on the card. The errors on the test are compared with test results of other children of the same age; if the number of errors exceeds a certain amount, then brain dysfunction is suspected. This test is less sophisticated than other neuropsychological tests because the nature or location of the problem cannot be determined with this test. The Bender Visual-Motor Gestalt Test can be useful for psychologists, however, because it provides a simple screening instrument that is easy to administer and can detect possible problems (Can be divided into two categories- One category includes procedures that examine the structure of the brain, such as the size of various parts and whether they are damaged. In the second category are procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic activity)

Question 34

positron emission tomography (PET scan)

Answer 34

Someone undergoing a PET scan is injected with an imaging tracer, a chemical attached to a radioactive isotope. The chemical component of a PET tracer is carefully selected to target a specific function in the body—for example, a metabolic process or neurotransmission. The PET scanner uses rings of detectors to measure the radioactive decay of the tracer, which accumulates at certain sites. Images representing the distribution of the tracer in the body are constructed. More important, PET scans are used increasingly to look at varying patterns of glucose metabolism that might be associated with different disorders. Recent PET scans have demonstrated that many patients with early Alzheimer’s-type dementia show reduced glucose metabolism in the parietal lobes.

Question 35

single photon emission computed tomography.

Answer 35

It works very much like PET, although a different tracer substance is used, and it is somewhat less accurate. It is also less expensive, however, and requires far less sophisticated equipment to pick up the signals. For this reason, it is used more frequently.

Question 36

Neuropsychological testing

Answer 36

system functioning by testing an individual’s performance on behavioural tasks.

Question 37

What is the disadvantage of neuropsychological testing?

Answer 37

With this use of neuropsychological tests, however, we face the issue of false positives and false negatives. For any assessment strategy, the test will occasionally show a problem when none exists (false positive) and will not find a problem when indeed some difficulty is present (false negative). The possibility of false results is particularly troublesome for tests of brain dysfunction; a clinician who fails to find damage that exists might miss an important medical problem that needs to be treated

Question 38

Psychological assessment

Answer 38

Measurement of changes in the nervous system reflecting psychological or emotional events, such as anxiety, stress, and sexual arousal.

Question 39

Electroencephalogram

Answer 39

Measure of electrical activity patterns in the brain taken through electrodes placed on the scalp. When brief periods of EEG patterns are recorded in response to specific events, such as hearing a psychologically meaningful stimulus, the response is called an event-related potential or evoked potential. EEG patterns are often affected by psychological or emotional factors and can be an index of these reactions. In a normal, healthy, relaxed adult, waking activities are characterized by a very regular pattern of changes in voltage termed alpha waves.

Question 40

Classical categorial approach

Answer 40

Classification method founded on the assumption of clear-cut differences among disorders, each with a different known cause. Here we assume that every diagnosis has a clear underlying pathophysiological cause, such as a bacterial infection or a malfunctioning endocrine system, and that each disorder is unique.

Question 41

Dimensional Approach

Answer 41

Method of categorizing characteristics on a continuum rather than on a binary, either-or, or all-or-none basis.

Question 42

Prototypical approach

Answer 42

System for categorizing disorders using both essential, defining characteristics and a range of variation on other characteristics.

Question 43

Dementia praecox

Answer 43

Dementia praecox refers to deterioration of the brain that sometimes occurs with advancing age (dementia) and develops earlier than it is supposed to, or prematurely (praecox). This label (later changed to schizophrenia) reflected Kraepelin’s belief that brain pathology is the cause of this particular disorder

Question 44

Changes for the DSM-III

Answer 44

First, the DSM-III attempted to take an atheoretical approach to diagnosis, relying on precise descriptions of the disorders as they presented to clinicians rather than on psychoanalytic or biological theories of etiology. With this focus, the DSM-III became a tool for clinicians with a variety of points of view.

The second major change in the DSM-III was that the specificity and detail with which the criteria for identifying a disorder were listed made it possible to study their reliability and validity. Although not all categories in the DSM-III (and its 1987 revision, DSM-III-R) achieved perfect or even good reliability and validity, this system was a vast improvement over what was available before.

Became popular due to:Primary among them were its precise descriptive format and its neutrality with regard to presuming a cause for diagnosis. The multiaxial format, which emphasizes a broad consideration of the whole individual rather than a narrow focus on the disorder alone, was also thought to be useful. Therefore, more clinicians around the world used the DSM-III-R at the beginning of the 1990s than the ICD system, which was designed to be applicable internationally

Question 45

Difference between the DSM-IV and the ICD-10

Answer 45

The DSM-IV task force decided to rely as little as possible on a consensus of experts. Any changes in the diagnostic system were to be based on sound scientific data. The revisers attempted to review the voluminous literature in all areas pertaining to the diagnostic system (Widiger et al., 1996, 1998) and to identify large sets of data that might have been collected for other reasons but that, with reanalysis, would be useful to the DSM-IV. Finally, 12 independent studies or field trials examined the reliability and validity of alternative sets of definitions or criteria and, in some cases, the possibility of creating a new diagnosis.

Question 46

The DSM-5 changes from the DSM-IV

Answer 46

The general consensus is that the DSM-5 is largely unchanged from the DSM-IV, although some new disorders are introduced and other disorders have been reclassified. There have also been some organizational and structural changes in the diagnostic manual itself. For example, the manual is divided into three main sections. The first section introduces the manual and describes how best to use it. The second section presents the disorders themselves, and the third section includes descriptions of disorders or conditions that need further research before they can qualify as official diagnoses.

Question 47

New things contained in the DSM-5

Answer 47

introduces cross-cutting dimensional symptom measures. These assessments are not specific to any particular disorder but rather evaluate, in a global sense, important symptoms that are often present across disorders, in almost all patients. Examples include anxiety, depression, and problems with sleep (The idea is to monitor the symptoms, if present, across the course of treatment for the presenting disorder)

Question 48

DSM-III and DSM-5 similarities

Answer 48

the DSM-III and DSM-IV facilitated a more complete picture of the individual.