Chapter 3 (Adult) Flashcards
What is a clinical assessment?
The systematic evaluation and measurement of psychological, biological and social factors in an individual with possible psychological disorder.
Classical medical definition of a diagnosis?
The process of identifying a disease by its manifestations (symptoms, signs, results) of various special investigations.
Define diagnosis
Process of determining if a presenting problem meets established criteria for a specific psychological disorder.
2 components of diagnosis.
Securing symptoms and signs and interoperating adjunctive sources of information
The knowledge of normal functioning and behavior and their pathological counterparts required by diagnosis
What are signs and symptoms? Are they important to a psychologist for diagnosis?
- A symptom characterizes a state, condition or entity.
- symptoms indicate change from a former state.
- it is also a manifestation of a state or condition conceptualized as indicating an abnormality as indicated by the affected individual - A sign is a manifestation of a condition that may indicate abnormality observed by another person like a doctor or a psychologist.
Why is it usually difficult to differentiate between a symptom and a sign?
Other features of an issue are both a sign and a symptom. Eg, mood, sweaty palms and shaking.
What 3 things should be known for a diagnosis?
Who? Why? What?
- who is the person?
-why are they being consulted?
- what can be observed?
By what means do psychologists examine?
Observing mental state and behavior.
State 3 standardized test instruments
- Neuropsychological batteries
- Intelligence assessments
- Personality assessments.
State and explain the types of diagnosis
Phenomenological diagnosis- when only observed and reported information is available
Syndromal diagnosis- the refers to when the reoccurrence of predictable clusters of phenomena is recognized. There is more information known because there is enough observable phenomena
What is the so-called hypothetico deductive method?
An intermediate approach that best exemplifies the logical underpinnings of the diagnostic process
Outline the process of the so-called hypothetico deductive method
- The clinician forms a hypothesis about the problem from the onset
What combination of the approaches is best for a diagnosis?
- History- presents the main substance of the hypothesis
- A focused, further direct enquiry to confirm or refute the hypothesis
- An examination, which provides similar information to special investigations.
What are pathognomonic diagnosis
It means that there is one symptom or sign or set of symptoms of signs that uniquely define a condition. They are rare and relying on this approach is p e r i l o u s
Define delirium
When a syndrome and the available evidence does not shed anymore light on what the causes and what the outcomes might be
Name four things that indicate delirium
Decrease arousal
Poor attention
Cognitive disturbances hallucination
What are two rare examples of a e t i o l o g i c diagnosis in mental health
Huntington’s disease which is a major neuro cognitive disorder and neurosyphilis formally called general paresis of the insane
Why is functional diagnosis useful?
Allows us to consider the functional implications of a condition and and it’s useful in dramatic brain injury chronic psychotic conditions and neuro developmental disorders
What is a differential diagnosis?
Refers to a list of possible conditions that conform to the available clinical information
What is a final diagnosis
It is reached only after other disorders on the lists have been eliminated through further investigations
What is a syndrome
Implies the clustering of given symptoms signs and results of special investigations that occurs with sufficient regularity and predictability constituting a putative disease entity. A syndrome also refers to asset of Clinical and supporting information that coo occur at a frequency greater than change
What is a disease?
A disease consists of a combination of Clinical phenomenology course behavior pathogenesis and atlogy or initial cause
What three basic concepts that help determine the value of our assessment help lesions understand the different choice to assess psychological problems?
Reliability validity and standardization
Define reliability
Refers to the extent at which a measurement is consistent
Explain one way that psychologists improve fair reliability
Like carefully designing their assessment devices and then conducting research on them to ensure that two or more raters will get the same answers this is called inter-rater reliability
What is the test- retest reliability
A neurocognitive parameter such as attention span should remain stable from one assessment to the next
Define validity
Refers to weather or not something measures what it was designed to measure in this case whether a technique assesses what it is supposed to
What comparison is known as the concurrent or descriptive validity
Comparing the result of an assessment measure under consideration with the result of others that are better known which allows you to begin to determine the validity of the first measure
What is predictive validity?
It refers to how will your assessment tells you what will happen in the future
Define standardization
It is the process by which a certain set of standards or norms is determined for a technique to make its use consistent cross different measurements
To what do the standards apply?
Standards might apply to the procedures of testing scoring and evaluating data
What does the value of assessment depend on?
Reliability validity and standardization
What is another word for clinical interview? Why?
Clinical encounter or consultation the term interview gives the impression of a question and answers session which impedes the free flow of information that is important to get to the bottom of any presentation
State four features that should be considered in the clinical Encounter
The clinical encounter must be systematized, structured, goal- directed,and rooted in scientific understanding but should be natural and not threatening
- questions must be avoided so as to allow the patients to speak Revealing more information
- the system structure goals and scientific underpinningings should inform the clinician but should not prevent the two from interacting
What are the three legs of Clinical Encounter?
History mental state examination and behavioral observations
What is standardization?
That is the process of establishing specific norms and requirements for a measurement technique to ensure that is used consistently across a measurement occasions. It includes instructions for administering the measure evaluating it’s findings and comparing them to a data f o r numbers of people
What does asking someone who they are informs you on…
Their name age where they reside who they live with relationships education current and past work religion and social support structures
What can the way in which someone tells you their age reveal?
The person’s cognitive ability motivation mood and reality testing
Does asking about past and present illnesses and treatments reveal
Vulnerability or strengths
What does asking a person why help with?
It tells you about the primary complaint what troubles the person what is on their mind or sometimes how they believe the problem to be which often sheds light on the diagnostic hypothesis
You’ll be fine.
Keep pushing!
What can the clinician tend to with the information obtained from the presenting complaint?
They can ask Direct questions
What is the most difficult for clinicians to ask?
To ask about psychotic phenomena for example the Conundrum that is faced by practitioners is how to ask someone if they’re hearing voices without actually asking it
State the 6 elements of Clinical history
- Identifying the demographic information
- Primary or presenting complaint
- Systematic inquiring
- Medical history
- Habits
- Psychosocial adaption and functioning
State nine aspects under identifying demographic information in clinical history
- Age
2.home
3.relationship status - name
- education
- Children and dependants 7.language
- occupation
- Financial security religion
Name six aspects concerning primary or presenting complaints in the elements of Clinical history
- The nature
- associated features
- severity
- temporal pattern
- aggravating and relieving factors 6. onset course and development
Which clusters of symptoms must be surveyed in systematic enquiry?
- Mood, emotions and feelings- stability, reactivity, hopelessness, irritability
- Anxiety- apprehension, abdominal discomfort, panic
- Neurovegetative features -sleep quality and quantity, nightmares, energy and motivation.
- Obsessions and compulsions- ability to recognize their origin and to resist.
- Reality testing- perceptual disturbancesike hallucinations, illusion, delusions, magic thinking
- Withdrawal indicators- cravings and other features of specific withdrawal syndromes.
- Other symptoms like dissociation phenomena, somatic concerns, mnestic (memory) distortions like Deja vu, forced thinking, parasitised thoughts, etc.
What is a mental state examination?
part of the medical examination and an addition to the neurological examination (often referred to as higher functions(cognition feeling and bought as opposed to motor and sensory function) by non-psychiatrists)
What does the mental state examination involve?
Systematic observation of a person’s State of Consciousness arousal cognitive ability feelings and emotions thinking thoughts communication and behavior
What is the mental state examination?
Is the product of observation using all our senses that is reported in a systematic way. This type of observation occurs when any one person interact with each other
How does systematically and consistently reporting mental state findings helped clinicians?
It makes communication is your and more accurate between clinicians
What is a mental state examination?
It is a brief but systematic overview of global mental functioning across the domains of consciousness cognitive functions emotions reality testing and behavior.
Outline the six ways to approach and record mental state
- A hierarchical systematic approach
- Cognitive parameters indicating the integrity of the person’s central nervous system and general health
- impaired attention, memory and other cognitive functions may signal serious physical disease and can also better account for other psychological phenomena.
- Mood and affect because disturbances in these areas may explain disturbances in reality testing.
- And appraisal of reality testing- thinking thoughts, apperceptions and organization.
- description of motoric behaviors such as tension, fidgetiness, lethargy, mannerisms, stereotypes or movements disorders
Explain the six ways to approach and record mental state
- The one systematic approach to describing the mental state is hierarchical and considers the following domains- general appearance cognition mood and effect reality testing and organization behavior and uh description of general appearance is easy to make an provides useful information about appearance physical state contact and cooperation. Secondly cognitive parameters provide an indication of the integrity of the person’s central nervous system in general health- someone who lapses in an out of consciousness demands immediate attention. Describing a patient is comatose describes no less than that patients mental state and agree one at the. Thirdly impaired attention memory and other cognitive functions may signal a serious physical disease and can also better account for others icological phenomen- a person with newly emergent word finding problems and the inability to recognize faces warrant immediate examination for stroke. The patients neurological condition may explain other abnormal findings such as emotional incontinence. And other words cognitive disturbances trump other psychopathologies because of their potential severity risk to life as well as reversibility. Number four mood and affect follow next and are considered at the stage because mood and effective disturbances may often account for disturbances in reality testing. Number five appraisal of reality testing-thinking thoughts and organization and lastly the description of motoric behaviors such as tension fidgetiness lithargy minorisms movement disorders
State six mental state examination domains and features
- General appearance
- consciousness
- arousal and cognitive functions
- mood and affect
- reality testing
- motoric and other behaviors
State and explain the six domains and features of mental state examination
General appearance- mobility activity injuries hygiene neatness engagement interaction cooperation. Consciousness arousal and cognitive functions
Still under domains and features of mental state examination explain attention and memory under consciousness arousal and cognitive functions
Attention refers to focus sustain shift resist destruction and memory- for recent information typically presented verbally also assist other domains like episodic memory spatial memory
Still under domains and features under consciousness arousal and cognitive functions outline features of communication
Language- fluency understanding naming repetition reading and writing. Speech-the mechanical production of verbal communication. Language is symbolic communication and is not speech which is the mechanical production of verbal communication. Aphasia good first to language disturbance and disarthria refers to speech disturbance. Practice refers to performance of previously learned to complex multitasks. G n o s i s refers to the recognition of all things across all sensory modalities. Executive functioning refers to program solving concept formation planning organization execution solve monitoring and also subsums abstract reasoning and cognitive flexibility.
Identify each domain of the mental state examination and its features
- General appearance( mobility activity injuries hygiene neatness engagement interaction corporation)
- consciousness
- arousal and
- cognitive functions
- mood and effect
- Reality testing motoric and
- other behaviors and other observations
State the two levels of consciousness and give the features or cognitive factors for each level
- arousal; features:
-attention- focus sustain shift resist distraction.
-memory- for recent information typically presented verbally and also assesses other domains. - communication.
Features:
-language, speech, practice g n o s i s, executive functioning and estimates of general intelligence and adaptive functioning. Practice refers to the performance of previously learned to complex motor toss while G and o s i s refers to the recognition of things across all sensory modalities like faces and numbers. Executive functioning refers to problem solving concept formation planning organization execution so monitoring
What are the features of the mood and affect domain of mental state examination?
Mood- depressed irritable manic anxious reactivity. Affect- nature congruence range of expression and reactivity. Hedonic tone and motivation
State the features of the reality testing domain of mental state examination
Thinking-speed coherence associations logic. Thoughts- also referred to as thought content ideas delusions preoccupations and obsessions. A p p e r c e c t i o n s- hallucinations illusions misidentifications. Organization- logical organization of communication and behavior
State the features of the motoric and other behaviors domain under mental state examination
Intensity- agitation retardation purposefulness and goal-directedness. Adventitious behavior for example mannerisms and other movement disorders. Compulsions and Catatonia.
What do the abbreviations mmse m o c a stand for?
Mmse- f o l s t e i n mini Mental status examination. M o c a Montreal cognitive assessment
Purpose of the mmse and moca
They are standardized screening tools designed to detect cognitive impairment at the bedside.
They are also useful to monitor progress through serial administration.
What may physical issue may prese t eith panic only?
Cardiac ischaemia-insufficient blood supply to the heart muscle
What is the mode of an under functioning thyroid? Thyroidism
Depression
What are the components of a physical examination ?
Physical assessment- History and examination (Physical examination: vital signs, general observations, cardiovascular, respiratory, abdominal, rectal examination, pelvic, urological and gynecological exam, musculoskeletal, ear nose and throat, eyes, oral cavity, dermatological, neurological).
Semistructured clinical interview
Behavioral assessment
How is physical history approached?
Exactlyhow clinical history is approached except thr practitioner focuses on physical symptoms and enquires into different physical systems in the systematic enquiry.
Explained at is meant by each aspect of physical examination.
Vital signs- blood pressure, pulse, respiration
General observations- distress, colour (jaundice, anaemia, etc), oedema (swelling) , bruising, nutritional state.
Cardiovascular- pulse, heart exam
Respiratory- observe chest movement, etc
Abdominal- observe, percuss and listen.
Rectal exam
Pelvic, urological and gynecological
Musculoskeletal- joints and bones
Ears, nose, throat
Eyes
Oral cavity qnd teeth
Dermatological- skin and appendages
Neurological- cranial nerves motor, somatosensory, cerebellum, gait and mental state exam
What are neurocognitive problems?
Impulsivity and problems with practice and communication
What are motor abnormalities?
They are encountered in psychotic disorders notably schizophrenia, usually during the physical examination for example patients may resist passive movements may hold limbs in an awkward posture or cool faces and may also attempt to assist often in a bizarre way with the examination technique
What is meant by the term nutritional changes?
It is evidence of recurring vomiting salivary gland in largement. C a r i o u s tth may alarm the doctor of ulimia bulimia nervosa
What what are tell signs of substance abuse?
Needle tracks in the arms and the groin(introvenous narcotic use) necrosis of the nasal septum ( cocaine snorting) nodules of the skin( met- aqualone use close)
What symptoms are often ready distinguishable from neurological lesions due to identifiable neuropathology?
The pseudo neurological symptoms
Differentiate between semistructured and unstructured interviews
Unstructured interviews follow no systematic format. In a semi structured interview, clinicians may depart from set questions to follow up on specific issues
Why are clinicians confident in semi structured interviews?
Because the wording and sequencing of questions has been carefully worked out over a number of years
Explain one drawback if a semi structured clinical interview is applied to rigidly
It may inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked. This job back has hindered the use wide acceptance of fully structured interviews which are sometimes entirely computer-based
What is the purpose of semi-structured interviews?
to explore specific suspected abnormalities
What is the ‘anxiety disorders interview schedule for dsm- 5’?
An example of a semi-structured interview whereby a clinician first asks if the patient is bothered by obsessions or feels compulsions
What is a behavioral assessment?
It uses Direct observation to formally assess an individual’s thoughts feelings and behavior in specific situations
When are behavioral assessments more appropriate than interviews?
When assessing individuals who are not old enough or skilled enough to report their problems and experience
What is the target behavior when it comes to behavioral assessment?
The identified cause of bother in the particular person
How do you know if someone’s claims are truthful?
Clinicians sometimes arrange analogue settings which are settings that are similar to the one under scrutiny normally for children who are self- injurious( self-hitting and head brushing) and autistic which are discovered by placing the children in simulated situations like sitting alone at home or playing with a sibling asked to complete a difficult task
Name the eight different assessment techniques
1.The clinical encounter
2. physical examination 3.semi-structured clinical interviews
4. behavioral assessment 5.psychological testing and 6.neurosychological testing
7. neuroimaging 8.psychophysiological assessment
What is a clinical assessment?
It is the systematic evaluation and measurement of psychological biological and social Factors in an individual presenting with a possible psychological disorder
What is a diagnosis?
The process of identifying a disease by its manifestations- symptoms signs and results of various special investigations
two components that the diagnostic process relies on to reach a diagnostic conclusion
- Securing symptoms and signs and interpreting ajunctive sources of information.
- Diagnosis requires knowledge of normal functioning and behavior and their pathological counterparts
Differentiate between a sign and the symptom
Symptom; characterizes Estate condition or entity and especially indicates change from a former state. Sign; is a manifestation of a condition that may indicate of normality which is observed by another person
What does a diagnosis follow in its most basic form?
It follows an algorithm where all observations are considered against all their possible causes
What is the intermediate approach (hypothetical deductive method)?
It is when the clinician forms a hypothesis about the problem right from the outset
Define the concept p a t h o g n o m o n i c diagnosis
It states that there is one symptom or sign or a set of symptoms or signs that uniquely define a condition