Chapter 3 Clinical Assessment and Diagnosis

Question 1

Clinical assessment

Answer 1

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

Question 2

Diagnosis

Answer 2

1. process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder
   - Diagnostic and Statistical Manual of Mental Disorders, or DSM-5

Question 3

Reliability

Answer 3

1. degree to which a measurement is consistent
2. We expect, in general, that presenting the same symptoms to different physicians will result in similar diagnoses.
3. One way psychologists improve their reliability is by carefully designing their assessment devices and then conducting research on them to ensure that two or more raters will get the same answers- inter-rater reliability
4. Determine whether these assessment techniques are stable across time- test-retest reliability

Question 4

Validity

Answer 4

1. whether something measures what it is designed to measure, whether a technique assesses what it is supposed to.
2. Comparing the results of an assessment measure with the results of others that are better known- concurrent or descriptive validity

Question 5

Predictive validity

Answer 5

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

Question 6

Standardization

Answer 6

1. process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measurements
2. Might apply to the procedures of testing, scoring, and evaluating data

Question 7

Mental status exam

Answer 7

1. to organize information obtained during an interview
2. The systematic observation of an individual’s behavior
3. Occurs when any one person interacts with another
4. Perform daily pseudo-mental status exams
5. Organize their observations of other people in a way that gives them sufficient information to determine whether a psychological disorder might be present
6. Can be structured and detailed
7. Covers five categories

Question 8

Mental Status Exam- Appearance and behavior

Answer 8

1. Physical behaviors
2. Individual’s dress, general appearance, posture, and facial expression
3. Psychomotor retardation

Question 9

Mental Status Exam- Thought processes

Answer 9

1. Rate or flow of speech
2. Continuity of speech
3. Does the patient make sense when talking, or are ideas presented with no apparent connection
4. Patients with schizophrenia, a disorganized speech pattern- loose association or derailment
5. Delusions- distorted views of reality

Question 10

Psychomotor retardation

Answer 10

Slow and effortful motor behavior- severe depression

Question 11

Delusions of persecution

Answer 11

someone thinks people are after him and out to get him all the time

Question 12

Delusions of grandeur

Answer 12

individual thinks she is all-powerful in some way

Question 13

Ideas of reference

Answer 13

everything everyone else does somehow relates back to the individual

Question 14

Hallucinations

Answer 14

things a person sees or hears when those things really aren’t there

Question 15

Homophobia

Answer 15

negative attitudes toward homosexuality

Question 16

Mental Status Exam- Mood and affect

Answer 16

1. Mood: predominant feeling state of the individual
2. Affect: feeling state that accompanies what we say at a given point
3. Thinking about a range of happy and sad things with no affect whatsoever- the affect is “blunted” or “flat”

Question 17

Mental Status Exam- Intellectual functioning

Answer 17

Clinicians usually make a rough estimate of intelligence that is noticeable only if it deviates from normal

Question 18

Mental Status Exam- Sensorium

Answer 18

1. Our general awareness of our surroundings

2. “Clear” = “Oriented times three” (to person, place, and time)

Question 19

Behavioral assessment

Answer 19

1. takes this process one step further by using direct observation to assess formally an individual’s thoughts, feelings, and behavior in specific situations or contexts.
2. May be more appropriate than an interview in terms of assessing individuals who are not old enough or skilled enough to report their problems and experiences
3. Target behaviors are identified and observed with the goal of determining the factors that seem to influence them
4. May seem easy to identify what is bothering a particular person-> challenging
5. Measuring, observing, and systematically evaluating (rather than inferring) the client’s thoughts, feelings, and behavior in the actual problem situation or context.

Question 20

Self-monitoring/self-observation

Answer 20

1. people can also observe their own behavior to find patterns
2. Tell them exactly how big their problem is and what situations lead them to smoke more
3. Help clients monitor their behavior more conveniently
4. When behaviors occur only in private, self-monitoring is essential
5. Clinicians often ask patients to self-monitor their behavior to get more detailed information

Question 21

Reactivity

Answer 21

1. distort any observational data
2. The mere fact of your presence may cause them to change their behavior
3. Behaviors people want to increase, tend to increase, and behaviors people want to decrease, tend to decrease when they are self-monitored.
4. Clinicians sometimes depend on the reactivity of self-monitoring to increase the effectiveness of their treatments

Question 22

Projective tests

Answer 22

1. include a variety of methods in which ambiguous stimuli
2. Are presented to people who are asked to describe what they see
3. People project their own personality and unconscious fears onto other people and things- ambiguious stimuli, without realizing it, reveal their unconscious thoughts to the therapist
4. Based on psychoanalytic theory
5. Controversial but quite common, with a majority of clinicians administering them at least occasionally
6. The Rorschach inkblot test, the Thematic Apperception Test, and the sentence-completion method

Question 23

Face validity

Answer 23

the wording of the questions seems to fit the type of information desired.

Question 24

Personality inventories

Answer 24

self-report questionaires assess personal traits

• What matters is if people with certain disorders tend, as a group, to answer a variety of questions in a certain way, this pattern may predict who else has this disorder.
• The content of the questions becomes irrelevant.
• The importance lies in what the answers predict.

Question 25

Intelligence quotient/IQ

Answer 25

1. Scores were calculated by using the child’s mental age
2. This mental age was then divided by the child’s chronological age and multiplied by 100 to get the IQ score
3. Current tests use what is called a deviation IQ- a person’s score is compared only with scores of others of the same age; an estimate of how much a child’s performance in school will deviate from the average performance of others of the same age
4. Score on an intelligence test, estimating a person’s deviation from average test performance.

Question 26

Neuropsychological tests

Answer 26

1. Measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction
2. Assesses brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks

Question 27

False positives and false negatives

Answer 27

1. when the test shows a problem when none exists (false positive) and times when no problem is found even though some difficulty is present (false negative)
   - A clinical who fails to find damage that exists might miss an important medical problem that needs to be treated

Question 28

Neuroimaging

Answer 28

1. Ability to look inside the nervous system and take increasingly accurate pictures of the structure and function of the brain
2. Can be divided into two categories
   - Procedures that examine the structure of the brain
   - Examine the actual functioning of the brain by mapping blood flow and other metabolic activity

Question 29

Computerized axial tomography (CAT) scan or CT scan

Answer 29

1. The first neuroimaging technique
2. Developed in the early 1970s
3. Uses multiple X-ray exposures of the brain from different angles
4. X-rays are passed directly through the head
5. Relatively noninvasive and has proved useful in identifying and locating abnormalities in the structure or shape of the brain
6. In locating brain tumors, injuries, and other structural and anatomical abnormalities

Question 30

Magnetic resonance imaging (MRI)

Answer 30

1. Greater resolution (specificity and accuracy)
2. The patient’s head is placed in a high-strength magnetic field through which radio frequency signals are transmitted
3. These signals “excite” the brain tissue, altering the protons in the hydrogen atoms
4. Allows the computer to view the brain in layers -> enables precise examination of the structure
5. More expensive and originally took as long as 45 minutes
6. Newer versions of MRI procedures take as little as 10 minutes; the time and cost are decreasing yearly

Question 31

Positron emission tomography (PET) scan

Answer 31

1. Measuring the actual functioning of the brain
2. Are injected with a tracer substance attached to radioactive isotopes, or groups of atoms that react distinctively
3. This substance interacts with blood, oxygen, or glucose
4. What parts of the brain become active, blood, oxygen, or glucose rushes to these areas of the brain, creating “hot spots” picked up by detectors that identify the location of the isotopes
5. We can learn what parts of the brain are working and what parts are not

Question 32

Single photon emission computed tomography (SPECT)

Answer 32

1. Works much like PET
2. Different tracer substance is used
3. Is somewhat less accurate
4. Less expensive
5. Requires far less sophisticated equipment to pick up the signals
6. Is used more often than PET scans

Question 33

Functional MRI/fMRI

Answer 33

1. Work more quickly than the regular MRI
2. Using sophisticated computer technology
3. Take only milliseconds
4. Can actually take pictures of the brain at work, recording its changes from one second to the next
5. Measure the functioning of the brain
6. Have largely replaced PET scans in the leading brain-imaging centers
7. Allow researchers to see the immediate response of the brain to a brief event
8. BOLD-fMRI (Blood-Oxygen-Level-Dependent fMRI)- currently the most common fMRI technique used to study psychological disorders

Question 34

Psychophysiological assessment

Answer 34

1. assessing brain structure and function specifically and nervous system activity
2. Psychophysiology: measurable changes in the nervous system that reflect emotional or psychological events
3. May be taken either directly from the brain or peripherally from other parts of the body

Question 35

Electroencephalogram (EEG)

Answer 35

1. measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity
2. Brain waves come from the low-voltage electrical current that runs through the neurons
3. Can be assessed in both waking and sleeping states
4. Electrodes are placed directly on various places on the scalp to record the different low-voltage currents
5. Usually we measure ongoing electrical activity in the brain
6. Brief periods of EEG patterns are recorded in response to specific events- event-related potential (ERP) or evoked potential
7. Are often affected by psychological or emotional factors
8. Healthy, relaxed adult, waking activites -> a regular pattern of changes in voltage- alpha waves
9. Stress-reduction treatments -> increase the frequency of the alpha waves, relaxing the patients
10. During the deepest, most relaxed stage, 1 to 2 hours after a person falls asleep -> slower and more irregular than the alpha waves

Question 36

Electrodermal responding/ galvanic skin response (GSR)

Answer 36

measure of sweat gland activity controlled by the peripheral nervous system

Question 37

Idiographic strategy

Answer 37

1. determine what is unique about an individual’s personality, cultural background, or circumstances
2. Let us tailor our treatment to the person

Question 38

Nomothetic strategy

Answer 38

1. determine a general class of problems to which the presenting problem belongs
2. We are attempting to name or classify the problem
3. When we identify a specific psychological disorder in the clinical setting, we are making a diagnosis
4. We can also identify a general class or grouping of problems by determining a particular personality profile on a psychological test such as MMPI

Question 39

Classification

Answer 39

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- nomothetic strategy
-Assignment of objects or people to categories on the basis of shared characteristics.

Question 40

Taxonomy

Answer 40

classification of entities for scientific purposes or if the subject is psychology- behaviors

Question 41

Nosology

Answer 41

1. If you apply a taxonomic system to psychological or medical phenomena or other clinical areas
2. All diagnostic systems used in healthcare settings are nosological systems

Question 42

Nomenclature

Answer 42

describes the names or labels of the disorders that make up the nosology
-In a naming system or nosology, the actual labels or names that are applied. In psychopathology these include, for example, mood disorders or eating disorders.

Question 43

Classical (pure) categorical approach

Answer 43

1. classification originates in the work of Emil Kraepelin (1856-1926)
2. We assume that every diagnosis has a clear underlying pathophysiological cause
3. Each disorder is unique
4. The causes could be psychological or cultural instead of pathophysiological, but there is still only one set of causative factors per disorder, which does not overlap with those of other disorders
5. Each disorder is fundamentally different from every other, we need only one set of defining criteria, which everybody in the category has to meet.
6. Extremely important for a physician to make accurate diagnoses
7. To understand the cause of symptoms is to know what treatment will be effective
8. No similar type of underlying cause
9. Most psychopathologists bvelieve psychological and social factors interact with biological factors to produce a disorder.
10. Mental health field has not adopted a classical categorical model of psychopathology.
11. The classical categorical approach is clearly inappropriate to the complexity of psychological disorders

Question 44

Dimensional approach

Answer 44

1. note the variety of cognitions, moods, and behaviors with which the patient presents and quantify them on a scale
2. Have been applied to psychopathology in the past- particularly to personality disorders- they have been relatively unsatisfactory
3. Most theorists have not been able to agree on how many
   dimensions are required
4. Method of categorizing characteristics on a continuum rather than on a binary, either-or, or all-or-none basis.

Question 45

Prototypical approach

Answer 45

1. identifies certain essential characteristics of an entity so that you (and others) can classify it, but it also allows certain nonessential variations that do not necessarily change the classification
2. Increasing support in recent years
3. Combines some features of each of the former approaches
4. Requiring a certain number of prototypical criteria and only some of an additional number of criteria is adequate
5. Greater blurring at the boundaries of categories
6. Some symptoms apply to more than one disorder
7. Fitting best with the current state of our knowledge of psychopathology
8. Relatively user-friendly
9. Many possible features or properties of the disorder are listed, and any candidate must meet enough of them to fall into that category
   DSM-5

Question 46

Construct validity

Answer 46

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

Question 47

Familial aggregation

Answer 47

the disorder would be found among the patient’s relatives

Question 48

Criterion validity

Answer 48

when the outcome is the criterion by which we judge the usefulness of the diagnostic category

Question 49

Content validity

Answer 49

1. 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
   - You need to get the label right

Question 50

Multiaxial system

Answer 50

allowed the clinician to gather information about the individual’s functioning in a number of areas rather than limiting information to the disorder itself

Question 51

“Culture”

Answer 51

the values, knowledge, and practices that individuals derive from membership in different ethnic groups, religious groups, or other social groups, as well as how membership in these groups may affect the individual’s perspective on their experience with psychological disorders.

Question 52

“Cultural formulation”

Answer 52

allows the disorder to be described from the perspective of the patient’s personal experience and in terms of his or her primary social and cultural group

Question 53

Comorbidity

Answer 53

individuals are often diagnosed with more than one psychological disorder at the same time
-The presence of two or more disorders in an individual at the same time.

Question 54

Labeling

Answer 54

1. the label itself has negative connotations and contributes to stigma, which is a combination of stereotypic negative beliefs, prejudices, and attitudes resulting in reduced life opportunities for the devalued group in question, such as individuals with mental disorders.
2. Categorize intellectual disability
3. Based on the severity of the impairment or highest level of developmental ability that the individual could reach
4. Labels of these categories of cognitive impairment periodically as the stigma associated with them builds up
5. Began to be used in common language, they picked up negative connotations and were used as insults
6. As these terms gradually became pejorative, it was necessary to eliminate them as categories and come up with a new set of classifying labels that were less derogatory.
7. One recent development is to categorize intellectual disability functionally- is determined by how much assistance he or she requires rather than by his or her IQ score
8. DSM-55 “mental retardation”-> “intellectual disability”
9. Once labeled, individuals with a disorder may identify with the negative connotations associated with the label-> affects their self-esteem
10. Terms in psychopathology do not describe people but identify patterns of behavior that may or may not occur in certain circumstances
11. Whether the disorder is medical or psychological, we must resist the temptation to identify the person with the disorder

Question 55

Primary care settings

Answer 55

where a person goes first with a problem

Question 56

Threshold

Answer 56

minimum number of criteria required to meet the definition of a disorder

Question 57

To explore the possibility of creating a new diagnostic category, a study was undertaken that had three specific goals:

Answer 57

1. If mental health professionals carefully administered semistructured interviews (the ADIS-IV), would they find patients who fit the new category? Or would careful examination find the criteria for existing disorders that had been overlooked by health professionals not well trained in identifying psychological disorders?
2. If mixed anxiety-depression did exist, was it really more prevalent in medical primary care settings than in outpatient mental health settings?
3. What set of criteria would best identify the disorder?

Question 58

Classical categorical approach

Answer 58

Systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with a possible psychological disorder.

Question 59

False negative

Answer 59

Assessment error in which no pathology is noted (i.e. test results are negative) when it is actually present.

Question 60

False positive

Answer 60

Assessment error in which pathology is reported (i.e. test results are positive) when none is actually present.