Chapter 3 - Clinical Assessment and Diagnosis Flashcards
Clinical Assessment
The systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder.
Diagnosis
The process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder, as set forth in the fifth edition of the DSM-5 (Diagnosis and Statistical Manual of Mental Disorders)
Three basic concepts that help determine the value of the assessment
- Reliability
- Validity
- Standardization
Reliability
The degree to which a measurement is consistent.
**The diagnoses would be said to be unreliable because two or more “raters” did not agree on the conclusion. **
Interrater Validity
Psychologists carefully design their assessment devices and then conduct research on them to ensure that two or more raters will get the same answer.
Test-retest Reliability
If you go to the clinician on Tuesday and are told that you have an IQ of 110, you should expect a similar result if you retake the same test on Thursday.
Validity
Whether something measures what it is designed to measure - in this case, whether a technique assesses what it is supposed to.
Concurrent or Descriptive Validity
Comparing the results of an assessment measure under circumstances with the results of others that are better known allows you to begin to determine the validity of the first measure.
Standardization
The process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measures.
Might apply to the procedures of testing, scoring, and evaluating data.
Mental Status Exam
Used by many clinicians to organize information obtained during an interview.
Mental Health Exam Covers
- Appearance and Behavior
- Thought Processes
- Mood and Affect
- Intellectual Functioning
- Sensorium
Appearance and Behavior
The clinician notes any overt physical behaviors, general appearance, posture, and facial expression.
Though Processes
Psychologist looks for:
- Rate of flow of speech
- Does the person talk quickly or slowly?
- Continuity of speech
- Loose association or derailment - the patient may not make sense when talking, or ideas are presented with no apparent connection
- Delusions - Distorted view of reality
a.) delusions of persecution - someone thinks people are after him or her
b.) delusions of grandeur - an individual thinks she or he is all-powerful in some way. Having an idea in reference in which everything and everyone somehow relates to the individual.
c.) Hallucinations - things a person sees or hears when those things aren’t really there.
Mood and Affect
The mood is the predominant feeling of the state of the individual.
Affect, by contrast, refers to the feeling state that accompanies what we say at a given point.
Intellectual Functioning
- Do they have a reasonable vocabulary?
- Can they talk in abstractions or metaphors?
- How is the person’s memory?
Sensorium
Refers to our general awareness of our surroundings.
*Does the individual know what the date is, what time it is, where she or he is, who he or she is, and who you are?
Unstructured Interview
Follow no systematic format.
Semistructured Interview
Made up of questions that have been carefully phrased and tested to elicit helpful information in a consistent manner so that clinicians can be sure they have inquired about the most important aspects of particular disorders.
Physical Examination
If a patient presenting with psychological problems has not had a physical exam in the past year, a clinician might recommend one.
Many problems presenting as behavior, cognition, or mood disorders may, on careful physical examination, have a clear relationship to a temporary toxic state.
The toxic state could be caused by bad food, the wrong amount or type of medication, or the onset of a medical condition.
Behavioral Assessment
It uses direct observation to formally assess an individual’s thoughts, feelings, and behavior in specific situations or contexts.
The ABCs of Observation
a.) Ancedote (what happened before the behavior)
b.) Behavior
c.) Consequence (what happened afterward)
Informal Observation
Relies on the observer’s recollection, well as the interpretation, of the events.
Formal Observation
Involves identifying specific behaviors that are observable and measurable (called operational definition)
Operational Definition
It would be difficult for two people to agree on what “having an attitude” looks like. An operational definition, however, clarifies this behavior by specifying that this is “any time the boy does not comply with his mothers’s reasonable requests.”
Self-monitoring or Self-observation
People observe their own behavior to find patterns
Behavioral Rating Scale
A formal and structured way of observing behavior through checklists.
Brief Psychiatric Rating Scale
Assesses 18 general areas of concern, each symptom rated on a 7-point scale from 0 (not present) to 6 (extremely severe.)
Reactivity
A phenomenon that can distort any observation data. Any time you observe how people behave, the mere fact of your presence may cause them to change their behavior.
Different Types of Psychological Tests
- Intelligence Tests - designed to determine the structure and patterns of cognition
- Neuropsychological Tests - determine the possible contribution of brain damage or cognitive dysfunction to the patient’s condition.
- Neuroimaging - uses sophisticated technology to assess brain structure and function.
Projective Tests
Variety of methods in which ambiguous stimuli. Such as pictures of people or things are presented to people who are asked to describe what they see.
The theory is that people project their own personality and unconscious fears onto other people and things.
Three more commonly used projective tests
- Rorschach Inkblot test
- Thematic Apperception test
- Sentence-Completion method
Rorschach inkblot test
The test includes 10 inkblot pictures that serve as the ambiguous stimuli. The examiner presents the inkblot one by one to the person being assessed, who responds by telling what he sees.
Controversial because of the lack of data on reliability or validity, among other things.
A revised test called “Comprehensive System” specified how the cards should be presented, what the examiner should say, and how the responses should be recorded.
However, it is still deemed as controversial.
Thematic Apperception Test
It consists of 31 cards - 30 with pictures and 1 blank card - although only 20 cards are typically used during each administration.
Involves the examiner asking a relatively straightforward description of what the test taker sees; the instructions for the TAT ask the person to tell a dramatic story about the picture.
- Children’s test (CAT)
- Senior’s (SAT)
Face Validity
The questions in psychological tests published in mainstream magazines typically make sense when you read them.
The wording of the questions seems to fit the type of information desired.
Personality Inventories
(Self-Report Questionnaires that assess personal traits)
Questions not only need to make sense but also the answers must be in line with what the questions are designed to predict.
MMPI (Minnesota Multiphasic Personality Inventory)
Based on the empirical approach, that is the collection and evaluation of data.
The pattern of responses is reviewed to see whether it resembles patterns from groups of people who have specific disorders.
MMPI-2 Revised Form
Eliminated problems with the original version, problems partly resulting from the original selective sample of people and partly resulting from the wording of questions.
Intelligence Quotient
Score based on the Stanford-Binet Test that predicts academic success.
WAIS-IV (Weschler intelligence Scale)
Includes WISC-V (Weschler Intelligence Scale for Children) & WPPSI-IV (Weschler Preschool and Primary Scale of Intelligence)
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)
Neuropsychological Test
Measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction so that the clinician can make educated guesses about the person’s performance and the possible existence of brain impairment.
Bender Viusual-Motor Gestalt Test
Fairly simple neuropsychological test often used with children
Two most popular advanced tests of organic (brain) damage that allow a more precise determination of the location of the problem
- Luria-Nebraska Neuropsychological Battery
- Halstead-Reitan Neuropsychological Battery
False Positives
Times when a test shows a problem when none exists
False Negatives
Times when no problem is found even though some difficulty is present
Neuroimaging
The ability to look inside the nervous system and take increasingly accurate pictures of the structure and function of the brain.
Different types of neuroimaging
- CAT or CT Scan (Computerized axial tomography)
- MRI (Magnetic resonance imaging
- PET scan (Positron emission tomography)
- SPECT scan (Single photon emission computed tomography)
- fMRI (Functional magnetic resonance imaging
- BOLD-fMRI (Blood-Oxygen-Level-Dependent functional magnetic resonance imaging)
Psychophysiological Assessment
Another method for assessing brain structure and function specifically nervous system activity.
Psychophysiology
Refers to the measurable changes in the nervous system that reflect emotional or psychological events
Electroencephalogram (EGG)
Measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity; brain waves come from the low-voltage electrical current that runs through the neurons.
Event-related potential (ERP) or evoked potential
The response when brief periods of WWEEG patterns are recorded in response to specific events, such as hearing a psychologically meaningful stimulus.
Idiographic Strategy
Utilizing an individual’s personality, cultural background, or circumstances to tailor their treatment.
Nomothetic Strategy
Determining a general class of problems to which the presenting problem belongs to, by attempting to classify the problem.
Classifications
It refers simply to any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations.
Taxonomy
The classification of entities for scientific purposes, such as insects, rocks, or - if the subject is psychology - behaviors.
Nosology
Applying taxonomic systems to psychological or medical phenomena or other clinical areas.
All diagnostic systems used in health care settings, such as infectious diseases.
Nomenclature
Describes the names or labels of the disorders that make up the nosology.
Classical (or pure) categorical approach
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.
Still only one set of causative factors per disorder, which does not overlap with those of other disorders.
Dimensional Approach
We note a variety of cognitions, moods, and behaviors with which the patient presents and quantify them on a scale.
Prototypical Approach
This alternative identifies certain essential characteristics of any entity so that you (and others) can classify it, but it also allows certain nonessential variations that do not necessarily change the classification.
Construct Validity
This means the signs and symptoms chosen as criteria for the diagnostic category are consistently associated or “go together” and what they identify differs from other categories.
Familial Aggregation
The extent to which the disorder would be found among the patient’s relatives.
Predictive Validity
A valid diagnosis tells the clinician what is likely to happen with the prototypical patient; predicting the course of the disorder and the likely effect of one treatment or another.
Criterion Validity
When the outcome is the criterion by which we judge the usefulness of the diagnostic category
Content Validity
This simply means that if you create criteria for a diagnosis of, say, social phobia, it should reflect the way most experts in the field think of social phobia, as opposed to, say, depression. (Getting the label right)
Subthreshold
Many times disorders such as OCD would be rated a 2 or 3, meaning that all of the symptoms are there but in too mild a form to impair functioning.
Cormobility
We have fuzzy categories that blur at the edges, making diagnostic decisions difficult at times, which causes individuals to be diagnosed with one or psychological disorders at one time.
Labeling
A related problem that occurs any time we categorize people
