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 possible psychological disorder.
Diagnosis
Process of determining whether a presenting problem meets the established criteria for a specific psychological disorder.
Adult Psychopathology
Scientific study of psychological disorders in adulthood (e.g. the nature, causes, and treatment of psychological disorders)
To reach a DIAGNOSTIC CONCLUSION the diagnostic process relies on 2 components:
- Securing symptoms and signs and interpreting sources of information
- Psychological tests
- Reports by third parties
- Laboratory investigations - Requires knowledge of normal functioning and behaviour and their pathological counterparts
- The experienced clinician integrates these 2 components/bodies of knowledge into 1 whole.
Symptoms
It is a manifestation of a state or condition which indicates an abnormality as reported by the affected individual.
- Characterises a state; condition; or entity.
- It indicates the perceived presence or absence of something.
- Indicate change from a former state
Sign
Is observed by another person - doctor, dentists, psychologists.
- Detecting signs requires keen observation and the use of all our senses
What 3 things do we want to know about the DIAGNOSTIC PROCESS
- WHO is the person being consulted?
- WHY is the person being consulted?
- WHAT is it that can be observed?
Purpose of the diagnostic process
To understand the person and the situation.
Diagnostic Paths
- Algorithmic approach
- Pattern recognition approach
- Hypothetico deductive method
- Pathognomonic diagnosis
Algorithmic approach
Step-by-step approaches to solving a problem
Pattern-recognition approach
Recognising patterns
Hypothetico deductive method
A hypothesis about the problem is formed where the history forms the main substance of the hypothesis.
Pathognomonic diagnosis
1 symptom/sign or a set of symptoms/signs that uniquely define a condition. Clinician starts by ruling out problems in some areas and starts to focus on more relevant areas.
Types of diagnosis
- Experiental or phenomenological diagnosis
- Syndromal diagnosis
- Pathogenic and Aetiological diagnosis
- Functional diagnosis
- Differential diagnosis
Disease
Pathophysiological response to external and internal factors.
Disorder
The disruption to regular bodily structure and function
Syndrome
A disease or a disorder that has more than one identifying feature or symptom. A collection of signs and symptoms associated with a specific health-related cause.
Condition
An abnormal state of health that interferes with the usual activities of feeling of wellbeing.
Values of assessment depends on:
- Reliability: degree to which a measurement is consistent
- Validity: degree to which a technique measures what it intends to measure
- Standardisation: process of establishing specific norms and requirements for a measuring technique to ensure it is used consistently across measurement occasions
Reliability: degree to which a measurement is consistent
- Test-retest reliability - consistency across time
- Inter-rater reliability - consistency across two or more raters
Validity: degree to which a technique measures what it intends to measure
- Concurrent validity – extend to which the results of one assessment measure corresponds with that of an existing measure
- Predictive/criterion validity – ability of an assessment measure to predict a future outcome
Standardisation: process of establishing specific norms and requirements for a measuring technique to ensure it is used consistently across measurement occasions
Standards might apply to the procedures of:
- Testing,
- Scoring,
- Evaluating of data
Assessment techniques:
- Clinical Encounter
- Physical examination
- Semi structured clinical interviews
- Psychological testing
- Neuropsychological testing
- Neuroimaging
- Psychophysiological assessment
Clinical Encounter
→ Systematic, structured, goal-directed conversation.
→ Open-ended questions
→ Relaxed, unthreatening & empathetic environment
What 3 elements does the clinical encounter involve?
- Clinical history
- Mental state examination
- Behavioural observations/assessments
What is Clinical history and what does the Clinician enquire about?
Concerned with asking questions to answer who; what; and why questions.
Enquire about:
→ Demographic information
→ Social & Developmental background
→ Experiences & past or current significant events
Name a few elements of clinical history
→ Identifying demographic information
→ Primary/presenting complaint
→ Systematic inquiry
→ Medical history
→ Habits
→ Psychosocial adaption & functioning
Primary complaint vs Systematic enquiry
Primary complaint: The problem foremost in the mind of the patient.
Systematic enquiry: A tool to include, or exclude, symptoms that accompany this presenting problem.
