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PSYC-3700 Abnormal Behavior in Adults > Chapter 3: Clinical Assessment > Flashcards

Chapter 3: Clinical Assessment Flashcards

1
Q

Clinical Assessment: the ____ evaluation and ___ of psychological/behavioral, biological, and ____ factors in an individual that is _____ with a possible psychological disorder

A

Clinical Assessment: the SYSTEMATIC evaluation and MEASUREMENT of psychological/behavioral, biological, and SOCIAL factors in an individual that is PRESENTING with a possible psychological disorder

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2
Q

a clinical assessment requires a ____ and ___ approach about gathering info about a client to make____ and____ decisions

A

a clinical assessment requires a INTEGRATIVE and MULTIDIMENSIONAL approach about gathering info about a client to make INFORMED and ACCURATE decisions

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3
Q

DIAGNOSES

A

THE PROCESS OF DETERMINING WHETHER THE PROBLEM SYMPTOMS AFFECTING THE INDIVIDUAL MEETS ALL THE CRITERIA FOR A PSYCHOLOGICAL DISORDEER, ACCORDING TO DSM5

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4
Q

2 broad steps when assessing psychological disorder

A

1) clinician collects a BROAD range of info about individuals functioning to determine the SOURC of a problem. Gets a PRELIMINARY sense of overall functioning of the person
2) narrow the focus by ruling out problems in some areas, and focusing on areas that seem more relevant.

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5
Q

3 concepts that determine the value of the clinical assessment

A

1) Reliability:degree to which a measurement is consistent
2) validity: degree to which a technique measures what it is designed to measure
3) standardization: application of standards to ensure consistency across dif measurements

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6
Q

standardization: application of standards to ___ ____ across dif measurements

A

standardization: application of standards to ensure consistency across dif measurements

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7
Q

degree to which a technique measures what it is designed to measure

A

VALIDITY: degree to which a technique measures what it is designed to measure

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8
Q

what type of reliability ensures that the technique/protocol is stable over time?

A

test-retest reliability

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9
Q

when 2 or more raters who use the same device on the same person and get the same results, this protocol has high ____ reliability

A

inter-rater reliability

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10
Q

concurrent validity

A

comparing the results of one asssessment measuring to the results of another in order to determine the validity of the first measure.

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11
Q

predictive validity

A

how well your assessment tells you what will happen in the future

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12
Q

Mental status exam: the systematic ____ of behavior: clinicians get enough info to determine the presence of a psychological disorder

when does this occur?

A

the systematic OBSERVATION of behavior: clinicians get enough info to determine the presence of a psychological disorder

a mental status evaluation usually occurs during the clinical interview

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13
Q

5 categories of a mental status exam

A

1) appearance and behavior
2) thought processes
3) mood and affect
4) intellectual functioning
5) sensorium

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14
Q

what encompases the appearance and behavior aspects of a mental status exam

A

the observation of overt, physical behavior.

- twitches, style of dress, facial expression and tone.

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15
Q

what encompasses the thought processes aspects of a mental status exam

A

fast/slow speech, continuity, and content of speech.

  • strange diction?
  • reasonable flow and content ?
  • is there evidence of delusions, hallucinations of reference? (the feeling that everything anyone else does somehow relates back to them)
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16
Q

reference

A

the feeling that everything anyone else does somehow relates back to them

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17
Q

____ is the predominant feeling state of an indivdual, whereas an ____ is a transient feeling state that is accompanied by an action at a given time.

A

MOOD is the predominant feeling state of an indivdual, whereas an AFFECT is a transient feeling state that is accompanied by an action at a given time.

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18
Q

what encompasses the intellectual functioning aspects of a ____ is the predominant feeling state of an indivdual, whereas an ____ is a transient feeling state that is accompanied by an action at a given time.

A

general levels of functioning

-adequate vocabulary and grammar, ability to use metaphors and abstractions.

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19
Q

what is sensorium

A

our general awareness of our surroundings, ex/ knowing where we are, who the clinician is, the date etc.

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20
Q

Orientedx3

A

the “good” ranking of sensorium (CLEAR SENSORIUM), which means THEY KNOW THE PLACE, PERSON, AND TIME.

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21
Q

What does the clinical interview and mental status exam allow the clinician to make?

A

allows the clinican to make a preliminary determination of which areas of the patient’s behavior and conditions should be assessed in more detail/more formally

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22
Q

2 quantitative measures of the mental status exam

A

1) mini-mental state exam (MMSE)

2) montreal cognitive assessment (moCA)

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23
Q

a ____ interview is made up of questions that have been carefully phrased to elicit useful info in a consistent manner. Disadvantage to semi structured vs unstructured

A

SEMISTRUCTURED. ensures that clinicians have acquired the most pertinent info relating to a particular disorder, but also allows them to follow up on a specific issue.

disadvantage; decreased spontaneity quality of 2 ppl talking about a problem. If too rigid of an interview, people may not reveal vulnerable info.

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24
Q

why is a physical examination imporant to note when acquiring info for clinical assessment?

A

PE should be done in order to rule out medical conditions that are associated with psych disorders, and to rule out medical conditions that may masquerade as a psychological disorder.

ex/ hyperthyroidism can result in feelings of anxiety. this psych disorder is actually just due to a toxic state.

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25
Q

the purpose of a BEHAVIOURAL ASSESSMENT is to identify problems in ___ ____ and ____ ____ that may become targets of therapeutic intervention.

What method of assessment is used?

A

the purpose of a BEHAVIOURAL ASSESSMENT is to identify problems in TARGET BEHAVIOURS and ENVIRONMENTAL EVENTS that may become targets of therapeutic intervention

  • uses DIRECT observation to formally assess and individuals thoughts, feelings and behaviour in specific situations (environmental events).
  • target behaviours are identified and observed with the goal of determining the factors that seem to influence those behaviours.
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26
Q

during a obersvational behavioural assessment (when you look at behaviours in a specific environment), the clinicain needs to directly observe the behaviours in a naturalistic environment. If that isn’t possible, what is done?

A

If you cannot observe the individual in a naturalistic environment, you can set up an ANALOGUE in a lab that resembles the natural setting.

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27
Q

ABCs of Formal Observation (Observational behavioural assessment)

A

1) Antecedents: what happened just prior to the behaviour and setting events
2) Behaviour: current behaviour that is operationally defined.
3) consequences: what happens after the behaviour.

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28
Q

Goal of formal observation and collecting the ABCs

A

goal is to see whether there are any patterns of behaviour, and then to design a treatment based on these patterns.

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29
Q

informal observation

A

taking rough notes about what has occurred but not purposefully observing. There is no formal operational definition of behaviour.

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30
Q

why is behavioural assessment also called functional assessment

A

because a behavioural assessmet is sort of related to operant conditioning. we are observing what consequences are allowed/facilitating this behaviour. It is an analysis of context and consequences.

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31
Q

during a behavioural/functional assessment, a clear ____ ____ of the behaviour is being observed

A

operational definition

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32
Q

during a behavioural assessment, you are forming a hypothesis about what is ___ and ___ the behaviour

A

what is triggering and maintaining the behaviour.

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33
Q

treatments that are ____ based are more effective than treatments that focus just on adapting the behaviour itself.

A

treatments that are FUNCTIONAL-BASED (focuses on what causes + reinforces the behaviour) are more effective than treatments that focus just on adapting the behaviour itself.

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34
Q

example of how behavioural assessments can also be scaled questionaires

A

the motivational assessment scale.

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35
Q

what is functional analysis

A

an experiment that tests problem behaviour. often done in individuals who do not have the capacity to explain their behaviour themselves. Researchers need to see and trigger the behaviour, and to see what triggers the behaviour.

involves exposing the pt to varous reinforcing factors of the behaviour to gain better understanding of ABCs

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36
Q

A behavioural assessment can also take the form of ____ ____, when a person is asked to observe and record their own behaviour. Why is this type of behavioural assessment so important?

A

SELF MONITORING.important for when behaviours only occur in private.

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37
Q

reactivity

A

changes in behaviour as a result of knowing that one is being watched. Self monitoring reduces reactivity because a person is no onger being watched by someone else.

  • alternatively, self monitoring can cause reactivity and thus used to increase the effectiveness of treatments because the person is decreasing a behaviour they want to decrease.
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38
Q

during behavioural assessment, behaviorual ____ ___ can be used to more formally evaluate a behaviour and assess behaviour before/during/after an event.

A

behavioural rating scales.

39
Q

a pro of self monitoring as a method of behavioural assessment

A
  • important for when behaviours only occur in private.
  • allows for the study of covert behaviour (ex/ challenging thoughts and emotional response that researchers could not necessarily see by obsercation).
  • a self monitoring BRTC Diary Card: allows for self monitoring of certain thoughts and the frequency of the behaviour (ex/ suicidal ideation)
40
Q

a con of self monitoring as a method of behavioural assessment

A

behavioural reactivity: changes in behaviour as a result of the person knowing their being observed by either themselves of by someone else. this can occur in self-monitoring or clinician observation.

41
Q

Psychological Testing during clinical assessment needs to be reliable and valid. Psych testing includes tests to determine cognitive, emotional or behavioural responses that may be associated with a specific disorder. What are the 3 common types of psychological tests?

A

1) projective tests,
2) personality tests and
3) cognitive intelligence tests.

42
Q

what are projective psychological tests and what does it measure? What tradition does it rise from? What skill is required by the clinician?

A

projective psychological tests covers methods in which ambiguous stimuli are presented to a person who is then asked to state what he/she sees. the theory is that people will project their true, unconcious personality and reveal their hidden unconcious thoughts.

  • rises from psychoanalytical tradition
  • requires ability to interpret results.
43
Q

2 main types of projective psychological tests

A

1) rorschach inkblot

2) thematic appercation test (TAT): tell a story with diagrams on cards. tests imagination.

44
Q

cons of projective psychological tests

A
  • questionable reliability and validity– results are not consistent.
  • limits in standardization
45
Q

projective psychological test is an insight-based appraoch, meaning:

A

these psychological tests assume that the challenges an individual faces is due to unconscious problems. our problem behaviour is due to our attempts to repress thoughts subconciously.

46
Q

T/F personality inventories are more empirical than projective psychological tests.

A

true. it does not rely so much on interpretation. they are mainly huge questionnaires that can be standardized.

47
Q

What is the most common personality test

A

MMPI (minnesota multiphasic personality inventory) is the most common. it was actually designed to look for PDs, so it is sensitive to psychological problems. Very very long test.

48
Q

explain a persoanlity inventory that can measure a specific disorder

A

a revised psychopathy checklist (PCLR); uses a semistructured interview with clients, along with material from institutional files. Checklist of 20 characteristics – includes pathological lying and superficial charm

cannot use a normal questionnaire on psychopaths because they will just lie.

49
Q

purpose of why an IQ test was created

A

simon and binet developed IQ tests initially to predict how well individuals would do in school, and who would need remedial help. Includes attention, perception, memory, reasoning, and verbal comprehension.

50
Q

T/F: IQ is intelligence

A

false. it only tests mental components that would reliably predict the person doing well in our school system.

51
Q

2 components of the weschler tests

A

1) verbal scales: measure of vocabulary, knowledge of facts, short term mem and verbal reasoning
2) performance scales: assess psychomotorabilities, nonverbal reasoning,ability to learn new relationships etc.

52
Q

cons of a weschler intelligence test

pros

A

con: there are cultural discrepancies.
pros: heavily standardized

53
Q

4 intellectual abilities tested in a weschler adult test

A

1) verbal comprehension
2) perceptual organization
3) processing speed
4) working memory.

54
Q

example of a cognitive psychological test that isn’t an intelligence test

A

1) mini-mental state exam (MMSE)

2) montreal cognitive assessment (moCA)

55
Q

psychophysiology

A

measureable changes in the nervous system that reflects emotional/psychoogical events.

56
Q

psychophysiological assessment

A

methods of assessing brain structure and function specifically, and nervous system more generally.

57
Q

event related potential

A

brief priods of EEG patterrns that are recorded in response to specific events. aka evoked potential.

58
Q

in terms of EEG patterns, stress-reduction treatments aim to restore _____ wave dominance, which signified healthy relaxation.

A

alpha wave dominance.

59
Q

uneven EEG recording may be indicative of ____

A

seizures

60
Q

6 main clinical assessment methods/facets

A

1) preliminary assessment and mental status/state exam
2) behavioural assessment (observational or self report or analogue setting)
3) neuropsychological testing
4) neuroimaging
5) psychological testing
6) psychophysiological assessment

61
Q

purpose of neuropsychological testing

A
  • assesses abilities in areas including receptive and expressive memory, motor skills, perceptual abilities, and learning+abstraction.
  • allows clinician to make guesses about the person’s performance and existence of impairment.
  • observe brain damage/dysfunction by observing its effects on the persons ability to perform tasks.
62
Q

example of a neuropsychological test

A

bender visual-motor gestalt test: give children drawings on a card and ask them to copt it. significant errors to drawing= brain dysfunction suspected.

halsted-retan and lund-nebraska neuropsychological battery: assess variety of skill. compares rhythmic beats to test sound recognition, attention, and concentration. Assesses grip strength, tactile performance, learning and memory skills etc.

63
Q

pros and cons of neuropsychological testing

A

pros:
- useful for detecting organic damage and cognitive disorders
- may even predict cognitive disorders (ex/ delayed verbal recall may be indicative of Alzheimers).
- routinely paired with other measures, therefore, good reliability and validity.

cons:

  • false positives: test shows a problem when none exists
  • false negatives: test fails to detect a problem even though one exists. may miss an important medical problem.
64
Q

type 1 error is aka false ____

A

false positive. test shows a problem when none exists

65
Q

type II error is the non-rejection of a false null hypothesis (also known as a “false ____”

A

false negative.test fails to detect a problem even though one exists

66
Q

2 categories of neuroimaging

A

1) structural

2) functional

67
Q

methods of structural neuroimaging

A

1) CAT

2) MRI

68
Q

methods of functional neuroimaging

A

1) PETscan
2) SPECT: single photon emission computed tomography. less expensive than PET
3) fMRI

69
Q

_____ is the classification of a scientific context. if the subject is psychology, this is the classification of behaviour.

A

TAXONOMY is the classification of a scientific context. if the subject is psychology, this is the classification of behaviour.

70
Q

Nosology

A

application of taxonomic classification system to a psychological phenonmena.

71
Q

names and labels of the disorders that make up the nosology is known as

A

nomnclature.

72
Q

ICD10 is a public health classification system to classify health conditions, and mental/behavioural disorders. it is an international system that ensures ___ ___

A

consistent definition

73
Q

3 approaches to classifications/making a diagnosis

A

1) classical categorical appraoch
2) dimensional appraoch
3) prototypical approach

74
Q

classical categorical approach

A

the assumption that every diagnosis has a clear underlying psychophysiological cause (ex/ bacterial infection)

  • assumes that each disorder is unique –> there is only one set of causative factors for each disorder.
  • mental health field has not adopted this approach: psychopathologies are complex interactions between biological sociological and psychological factors.
75
Q

dimensional appraoch

A

classification approach that notes the variety of cognitions, moods, and behaviours with which the patient presents, and quantifies them on scale.

76
Q

prototypical approach:

A

identifis certain essential characteristics of an entity so it can be classified, but also allows for certain nonessential variation that do not necessarily change the classification

77
Q

which classification appraoch is the DSM based on?

A

prototypical approach

  • in order to meet depression syndrome, there is one essential characteristic: depressed mood. then, you have 4 other (varying) symptoms).
  • you must exhibit 5 symptons in the same 2 week period to be categorized with a specific disorder.
78
Q

medical/pathological disease model

A

inherently accepted when diagnosing. puts mental illness in the frame of medicine

79
Q

explain the problem with reliability in a classification context

A

personality disorder classification is largely unreliable and biased. PDs are largely diagnosed incorrectly. for example, more inexperienced and female clinicians diagnose borderline personality disorder. Pts who are white, female and poor tend to be overdiagnosed with BPD.

80
Q

predictive validity in a classification context

A

when a diagnosis can correctly predict the course of the disorder and the likely effect of a treatment

81
Q

criterion validity in a classification context

A

when the outcome is the criterion by which we judge the usefulness of a categorization/diagnosis/assessment

0does the assessment score relate to a criterion outcome measure?

82
Q

a valid diagnosis tells the clinician :

A

what is likely to happen with the prototypical patient. validity in a classification context is the extent to which the principle used in classifying an entity are effective in capturing the true nature of the entity.

83
Q

content validity

A

the criteria for diagnosis has content validity if the criteria reflects the way most experts in the field think of the disease. ie. you need to get the label right.

84
Q

2 main changes of DSM III

A

1) atheoretical: it relied on precise descriptions
2) specificity and detail for identifying a disorder made it possible to study the criterias reliability and validity. Focused on inter-rater reliability.
3) mutli-axial format: broad considerations of the whole individual rather than a narrow focus on the disorder alone.

before DSM 3, DSM 2 and 1 wasn’t as precise in their definitions and many countries still had their own systems of nosology, thus the same disorders were still being labelled differently.

85
Q

DSM 4 upgrades

A
  • used scientifically informed descriptions via literature reviews
  • conducted independent studies to test reliability and validity of criteria definitions
  • recognized that disorders are affected by both biological and social influences. they disintigrated the distinction between organically based firoders and psychologically based disorders
86
Q

DSM 5 upgrades

A
  • reflects the public mandate set by WHO
  • provides clinicians with more info for assessment, treatment planning and monitoring
  • uses acis to rate intensity, frequency, and duration of disorders.
  • structural changes of DSM: 1) how to use the book
    2) criteria for disorders
    3) disorders that need more research.
87
Q

____ ____ allows a disorder to be described from the perspective of the patients personal experience and in terms of primary, social, and cultural groups.

A

CULTURAL FORMATIONS.

  • does the pt have the same terms and descriptions to describe a disorder? does the patient accept western models of a disease?
  • what does it mean to have a disability in their culture?
88
Q

concerns/criticisms baout DSM 5

A
  • overrepresentation of medical views on mental disorders and their treatment
  • reliability issues: fuzzy categories that blur edges – make diagnosing difficult, and results in comorbidity.
  • not enough validity: DSM diagnoses are based on consensus about clusters of clinical symptoms, not any objective lab measure.
  • definitions to describe symptoms are sometimes outdated and are thus flawed. but we use them because of colloquialisms.
89
Q

stigma

A

combination of stereotypic, negative beliefs, prejudices, and attitudes resulting in reduced life opportunities.

90
Q

spectrum

A

describes groups of disorders that share certain basic biological or psychological qualities or dimensions.

  • sometimes its hard to create strict, specific underlying causes for each disorder.
  • it is now assumed that neurobiological processes will be discovered that are associated with cognitive, emotional, or behavioural traits/patterns, but do not necessarily correspond with a SPECIFIC, SET IN STONE, diagnostic category.
91
Q
  1. Which of the following Greek philosophers suggested 15. Which of the following Greek philosophers suggested that maladaptive behaviour was rooted in social and cultural factors?
    a. Galen
    b. Hippocrates
    c. Plato
    d. Aristotle
A

C: plato

92
Q
  1. How does Gestalt therapy differ from psychoanalytic therapy?
    a. In Gestalt therapy, there is no delving into past experiences.
    b. In Gestalt therapy, the critical element is the therapist’s unconditional positive regard for the patient.
    c. In Gestalt therapy, there is little emphasis on the here and now.
    d. In Gestalt therapy, there is little or no training required for therapists.
A

A. In gestalt therapy, there is no delving into past experiences. They are focused on the present.

93
Q
  1. According to object relations theory, what does the concept of “introjection” refer to?
    a. a strong drive toward self-actualization and self-assessment
    b. the process of internalizing the images, memories, or values of an important person in one’s life
    c. the ability to adapt successfully to one’s environment
    d. projecting one’s own unacceptable feelings onto another individual or object
A

B: introjection: the process of internalization the images, memories, or values of an important person in one’s life.

PSYC-3700 Abnormal Behavior in Adults (24 decks)

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