Chapter 3: Clinical Assessment and Diagnosis(lecture) Flashcards
Clinical Assessment?
determination of how and why a person is behaving abnormally and how to treat.
Assessment?
collect all relevant info in an effort to reach a conclusion
Tools used in Clinical Assessment….3 main types!
Clinical Interviews (1st used) Test's Observations (usually done in the clin.interview)
Characteristics of assessment tools? 3
Standardized
Reliable
Valid
Standardization?
a test is used on a large group whose performance average serves as a norm against which individuals scores are compared to!
administration, scoring and interpretation must be standardized.
Reliability?
consistency of a test
a good test will give the same results in similar situations.
Test-retest Reliability
tested twice at 2 diff occasions and scores are correlated. higher correlation= high reliability.
Inter-rated reliability?
different judges independently agree on how to score, and interpret a particular test.
Validity??
accuracy of a test’s result… does it measure what it is suppose to be measuring?
Face Validity?
a test appears to measure what it is supposed to measure.
Predictive Validity?
a test accurately provides a prediction of future characteristics or behaviour
ex: highschool grades and university acceptance.
Concurrent Validity??
a test’s results agree with independent measures assessing similar characteristics or behaviour.
Clinical Interviews can either be….? 2
- Unstructured
2. structured
Unstructured Clinical Interviews
ask open ended questions,,,basically a free flowing interaction..like a normal conversation.
Structured Clinical interviews?
prepared questions are asked…often a from a published interview schedule….
Limitations of clinical interviews?
may lack validity
can be biased or make mistakes (unstructured)
miss information
lack reliability (unstructured)
Clinical Tests?
devices used for gathering info about specific topics from which broader info can be inferred. *follow up for what was taken away from the interview.
The Mental Status Exam ? 5 parts?
involves the systematic observation of somebody’s behaviour.
- Appearance and behaviour
- thought processes
- Mood and affect
- intellectual functioning
- sensorium
- Appearance and behaviour
any overt physical behaviours…
- thought processes
listen to a patients speech to get a good idea of their thought processes.
Looseness of association?
disjointed speech pattern
3.Mood and affect
Mood is the predominant feeling state of the individual. Affect by contrast is the feeling state that accompanies what we say at a given time
- Intellectual functioning
make a rough estimate of others intellectual functioning by talking to them. Vocabulary? abstract thought? memory? deviation from norm?
- Sensorium
our general awareness of our surroundings. (who they are, where, date, time)
oriented times three - to person, place and time.
Semeistructured Interviews
questions that are carefully phrased and tested….but they can deviate to follow up on specific issues.
Physical Examination?
if they have not had a physical in the last year they are required to have one.
many issues have a clear relationship to a toxic state.
Behavioural Assessment ?
direct observation to assess formally an individuals thoughts, feelings and behaviour in specific situations.
Target Behaviour?
what are identified in the behavioural assessment and observed with the goal of determining the factors that seem to influence those behaviours.
Naturalistic?
observe them in their natural environment aka home, school etc
The ABC’s of observation?
immediate behaviour, its antecedents (what happened just before), and its consequences (after it).
Relatively Informal Observation?
taking rough notes about what occurred, later elaborating in your office.
Formal Observation?
identifying specific behaviours that are observable and measurable…operational definition
Operational Definition?
once the target behaviour is identified, observer writes down the time it occurs, antecedent and occurrence..
Self monitoring?
people can observe their own behaviour to find patterns. …essential for when the behaviour only occurs in private settings.
Behaviour rating scales?
used as assessment tools before treatment and then periodically during treatment to assess changes in the persons behaviour.
Brief Psychiatric Rating Scale?
assesses 18 general ideas of concern. each symptom is rated on 7 pointed scale…0-6….screens for moderate to severe psychotic disorders…somatic, guilt feelings, grandiosity…
Reactivity?
can distort observational data….people behave differently in your presence …self monitoring corrects this..
Psychological Test?
Determine cognitive, emotional or behavioural responses that might be associated with a specific disorder
Types of subjective tests? 6
Projective, personality inventories, response inventories, psychophysiological tests, and neurological and neuropsychological tests and intelligence tests…
Projective Tests?
subjective tests…..**
client interprets vague and ambiguous stimuli or follow open ended instruction.. …theory? people project their own personality and unconscious fears onto other people and things in this case…
Rorschach Inkblot test (projective)
ten inkblot pictures that serve as ambiguous stimuli.
respond by telling them what they see….
Thematic Apperception Test (TAT- projective)
31 cards; 30 with pictures and one blank…tell a dramatic story about each picture..black and white btw
Sentence completion ? (projective)
Therapist starts a sentence that the client must finish…
Draw a person (DAP) (projective)
draw a person
gender, size, height etc all indicate their perception of reality…cog functions etc…
Children’s Apperception Test (CAT) and Senior Apperception Test (SAT) (projective)
variations of the TAT..
- Personality Inventories (psych test)
measure broad personality characteristics
focus on behaviours, beliefs, and feelings..
self reported responses…
standardized..! score is compared to profiles..
MMP-1 (Minnesota Multiphasic Personality Inventory)(personality tests)
statements describe physical concerns, mood, moral, attitudes towards religion sex social activities and psychological symptoms…
self statement test answered by T, F or cannot say
10 scales - clinical
scores range 0-120
above 70 = deviant
Four additional scales on MMP1 to determine validity.. and explain..
- Lie scale (L)- falsifying answers
- Infrequency (F)- are they answering randomly?
- Defensiveness (K)- sees themselves in unrealistically positive ways
- Cannot-Say (?)- how many times did they not answer?
Revised Psychopathy Checklist (PCL-R) (personality test) - Hare..
tests for behaviours and characteristics that some refer to as psychopathy …
basically using known information….to refer to they interview the individual and make note of what they lie about…..distort ..etc for pathological lying…superficial charm…etc..
- Intelligence Tests (psych test)
measure intellectual ability
series of tests that assess both verbal and non verbal skills…
generates an Intelligence Quotient.. (IQ)
con: can be influenced by other factors..motive …past exp…etc cultural bias..
IQ =?
mental age / chronological age
Deviation IQ?
score is only compared to those in the same age group
Wechsler Adult Intelligence Scale-III or children version..and preschool and primar scale of intelligence…what do they consist of?
verbal scales, performance scales……taps into verbal comprehension, perceptual organization, processing speed and working memory…
4.Neuropsychological and Neurological Tests
- indirectly assesses brain function by assessing cognitive, perceptual and motor functioning…
- directly assesses brain function by assessing brain structure and activity..
Bender Visual Motor Gestalt Test (neuropsych)
a series of cards on which are drawn various lines and shapes. task is to reproduce what was drawn on the cards…
Rhythm Test (neuropsych test)
which asks the person to compare rhythmic beats to test sound recog, attention, and conentration.
Strength of Grip Test(neuropsych)
compares the grip of the right and left hands
Tactile Performance Test (neruopsych)
requires test taker to place wooden blocks in a form board while blind folded to test learning and memory…
False positive?
False negative?
show a problem when none is there
show no problem when there is one..
Computerized Axial Tomography (CAT) or (CT) scan (neurology)
rel non invasive..
x rays are passed through the head….computer reconstructs various slices of the brain….b/c bone hinders it a bit…
Nuclear Magnetic Resonance Imaging (MRI) (neurology)
high strength magnetic field through which radio freq signals are transmitted…signals excite the brain tissue….altering protons in the hydrogen atoms..alteration is measured via time it takes for the protons to relax…..damage is indicated by lighter or darker spots.
Positron Emisson Tomography (PET) (Neurology) (functioning)
tracer subs attatches to radio active isotopes…interacts with blood, oxygen or glucose…….they rush to areas of the brain..when it becomes more active…creating hot spots…..picked up by detectors that identify the location of the isotopes…..see which parts are active and not..
Single Photon Emission Computed Tomography (SPECT) (neurology) (functioning )
different tracer is used…but same as PET scan…less accurate though….
fMRI……(neurology) (functioning)
allows researchers to see the immediate response of the brain to a brief event, such as seeing a new face….
- Psychophysical Test (psych test)
measures physiological response as an indication of psychological problems….
heart rate, blood pressure, body temp, galvanic skin response and muscle concentration..
Electroencephalogram (EEG) (psychophys)
measures electric activity in the head related to the firing of a specific group of neurons reveals brain wave activity…usually from the cortex
Event related potential (ERP-EEG)
when eeg recordings are in response to specific events such as hearing a meaningful stimulus…
Alpha Waves?
waking activities…regular changes in voltage …
Delta Waves?
seen in deepest parts of sleep…
Electrodermal Responding (skin conductance)
measures sweat gland activity controlled via PNS…
- Response Inventories (psych test)
ex: ?
self reported responses.. focuses on specific area of functioning ex:Beck Depression Inventory (affective inventory) Social skill inventories Cognitive Inventories ..
Analog (clin.obsv)
almost natural
mimic natural environment in lab setting
Classification?Nomothetic strategy..
effort to construct groups or categories and to assign people to these categories based on shared attributes or relations
Taxonomy?
scientific classifications
Nosology?
psychological or medical phenomena…..taxonomy aapplication
Nomenclature?
names or labels of disorders in nosology
Clinical Picture?
using all available information the clinician has gathered to try and come to a conclusion of the problem
Categorical Approach?
assume every diagnosis has a clear underlying pathophysiological cause..such as bacterial or malfunctioning endocrine syst..
Dimensional Approach?
note the variety of cognitions, moods, and behaviours with which the patient presents and qualify them on a scale…
Prototypical Approach?
identify certain essential characteristics of the entity so you can classify it…and allows for non essential variations that do not necessarily chance the classification.
DSM ***
Construct Validity?
information in a specific category differs from others
Content Validity?
should reflect what most experts say…..in the field the diagnosis category is covering…get the label right.
DSM structure?
Multi-axial? 5
list of disorders, symptoms, descriptions and guidelines for assessment…
Axis 1.Clinical Symptoms
Axis II. personality disorders
Axis III. General medical conditions
Axis IV. Psychosocial and environmental problems
Axis V. Global Assessment of Functioning Scale
Level of current functioning disability…
Mild
Moderate
Severe
- few symptoms, distressing but manageable
- number of symptoms, functional impairment
- many symptoms..
Comorbidity
diagnosed with more than one disorder..common
Labelling ?
to characterize the totality of an individual..
Stigma?
combination of stereotypic negative beliefs, prejudice and attitudes resulting in reduced life opportunities for the devalued group..
