Chapter 3: Clinical assessment and diagnosis

Question 1

Clinical assessment

Answer 1

The systematic evaluation and measurement of psychological, biological and social factors in an individual presenting with possible psychological disorder.

Question 2

Diagnosis

Answer 2

Process of determining whether a presenting problem meets the established criteria for a specific psychological disorder.

Question 3

Adult Psychopathology

Answer 3

Scientific study of psychological disorders in adulthood (e.g. the nature, causes, and treatment of psychological disorders)

Question 4

To reach a DIAGNOSTIC CONCLUSION the diagnostic process relies on 2 components:

Answer 4

1. Securing symptoms and signs and interpreting sources of information
   - Psychological tests
   - Reports by third parties
   - Laboratory investigations
2. Requires knowledge of normal functioning and behaviour and their pathological counterparts
   - The experienced clinician integrates these 2 components/bodies of knowledge into 1 whole.

Question 5

Symptoms

Answer 5

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

Question 6

Sign

Answer 6

Is observed by another person - doctor, dentists, psychologists.
- Detecting signs requires keen observation and the use of all our senses

Question 7

What 3 things do we want to know about the DIAGNOSTIC PROCESS

Answer 7

1. WHO is the person being consulted?
2. WHY is the person being consulted?
3. WHAT is it that can be observed?

Question 8

Purpose of the diagnostic process

Answer 8

To understand the person and the situation.

Question 9

Diagnostic Paths

Answer 9

• Algorithmic approach
• Pattern recognition approach
• Hypothetico deductive method
• Pathognomonic diagnosis

Question 10

Algorithmic approach

Answer 10

Step-by-step approaches to solving a problem

Question 11

Pattern-recognition approach

Answer 11

Recognising patterns

Question 12

Hypothetico deductive method

Answer 12

A hypothesis about the problem is formed where the history forms the main substance of the hypothesis.

Question 13

Pathognomonic diagnosis

Answer 13

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.

Question 14

Types of diagnosis

Answer 14

1. Experiental or phenomenological diagnosis
2. Syndromal diagnosis
3. Pathogenic and Aetiological diagnosis
4. Functional diagnosis
5. Differential diagnosis

Question 15

Disease

Answer 15

Pathophysiological response to external and internal factors.

Question 16

Disorder

Answer 16

The disruption to regular bodily structure and function

Question 17

Syndrome

Answer 17

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.

Question 18

Condition

Answer 18

An abnormal state of health that interferes with the usual activities of feeling of wellbeing.

Question 19

Values of assessment depends on:

Answer 19

• 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

Question 20

Reliability: degree to which a measurement is consistent

Answer 20

• Test-retest reliability - consistency across time
• Inter-rater reliability - consistency across two or more raters

Question 21

Validity: degree to which a technique measures what it intends to measure

Answer 21

• 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

Question 22

Standardisation: process of establishing specific norms and requirements for a measuring technique to ensure it is used consistently across measurement occasions

Answer 22

Standards might apply to the procedures of:
- Testing,
- Scoring,
- Evaluating of data

Question 23

Assessment techniques:

Answer 23

1. Clinical Encounter
2. Physical examination
3. Semi structured clinical interviews
4. Psychological testing
5. Neuropsychological testing
6. Neuroimaging
7. Psychophysiological assessment

Question 24

Clinical Encounter

Answer 24

→ Systematic, structured, goal-directed conversation.
→ Open-ended questions
→ Relaxed, unthreatening & empathetic environment

Question 25

What 3 elements does the clinical encounter involve?

Answer 25

1. Clinical history
2. Mental state examination
3. Behavioural observations/assessments

Question 26

What is Clinical history and what does the Clinician enquire about?

Answer 26

Concerned with asking questions to answer who; what; and why questions.

Enquire about:
→ Demographic information
→ Social & Developmental background
→ Experiences & past or current significant events

Question 27

Name a few elements of clinical history

Answer 27

→ Identifying demographic information
→ Primary/presenting complaint
→ Systematic inquiry
→ Medical history
→ Habits
→ Psychosocial adaption & functioning

Question 28

Primary complaint vs Systematic enquiry

Answer 28

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.