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 a possible psychological disorder.

Question 2

Diagnosis

Answer 2

The process of determining whether the particular problem afflicting the individual meets the criteria for a psychological disorder, as set forth in the DSM-5

Question 3

Value of assessments

Answer 3

1. Reliable: is it consistent
2. Valid: is it measuring what it should
3. Standardized: are standards applied appropriately

Question 4

The clinical interview: mental status exam

Answer 4

Systematic observation of behaviour in order to get enough information to determine whether disorder might be present. (Category of behaviour, severity of behaviour)

• covers five categories:
  1. Appearance and behaviour
  2. Thought processes (rate, continuity, content of speech)
  3. Mood and affect (affect appropriate, predominant feeling state)
  4. Intellectual functioning
  5. Sensorium (Oriented times three)

Question 5

The clinical interview: semi structured clinical interview

Answer 5

Clinical interviews can be unstructured or semi-structured

1. Unstructured: follows no systematic format
2. Semi-structured: Made up of questions that have been carefully phrased and tested it to elicit useful information in a consistent manner

Question 6

Physical examination

Answer 6

— conducted to lead to proper diagnosis in proper treatment
— attention to medical conditions associated with psychological disorder
— medical conditions and substance use can be underlying cause. (Important to look at onset of conditions to determine if they co-exist or if a causal relationship exists.)

Question 7

Behavioural assessment

Answer 7

— measuring, observing, evaluating the clients thoughts, behaviors, and feelings in the actual problem situation or context (home, school etc)
— target behaviours are identified and observed with a goal of determining factors that seem to influence those behaviours

Question 8

Behavioural assessment: ABC’s of observation

Answer 8

— antecedents: what happened just before the behaviour
— behaviour
— consequences: what happened after the behaviour

Question 9

Behavioural assessment: informal observation

Answer 9

Subject to observers interpretation and realize on recollection of events

Question 10

Behavioural assessment: formal assessment

Answer 10

— behaviours are defined, observable, and measurable
— goal is to see whether there are any obvious patterns of behaviour
— designer treatment based on these patterns

Question 11

Behavioural assessment: self-monitoring monitoring/self-observation

Answer 11

— people observe their own behaviour to find patterns using checklists or behaviour rating scales
— reactivity: anytime you observe someone’s behaviour, your presence can cause them to change. This can increase effectiveness of treatments or distort observational data.

Question 12

Psychological testing

Answer 12

— include specific test to determine cognitive, emotional, or behavioural responses that might be associated with a specific disorder
— general tests assess long-standing personality features
— specialized areas include: intelligence testing, neuropsychological testing, neurobiological procedures

Question 13

Psychological testing: projective testing

Answer 13

— psychoanalytic tradition
— people project personality and unconscious fears on to people or things and reveal unconscious thoughts
— controversial: assesses unconscious processes
— Rorschach inkblot test: Has questionable reliability and validity, Herman were shush developed 80 years ago, 10 inkblots are used, One of the earliest projective test used, I know includes a standardized version
— thematic apperception test (TAT): better known and widely used, 31 cards usually 20 are shown, participant tells a story about the picture, lacks reliability and validity making them less useful as a diagnostic test, can be good for getting people to open up, now have children and seniors test available

Question 14

Psychological testing: personality inventories

Answer 14

— Minnesota multiphasic personality inventory (MMPI): Most widely used, based on an empirical approach, 567 items, MMPI Dash a available for adolescence, pattern of responses is reviewed, includes four scales are determined validity of each administration

1. Lie scale (L): Indicates falsifying answers
2. Infrequency scale (F): Measures false claims or answering randomly
3. Defensiveness Scale (K): Assesses weather person sees them selves in unrealistically positive ways
4. Cannot say scale: Number of items not measured

Question 15

Psychological testing: personality inventories

Answer 15

—Revised psychopathy checklist (PCL-R): Assesses psychopathy, created by Robert Hare at UBC, youth version developed, used with previous institutional and/or prison records and information from significant others.

Question 16

Psychological inventory is: intelligence testing

Answer 16

— IQ test predicts who will do well in school (Alfred Binet, Standford-Binet)
— measured by how much the score deviates from the average of a same age individual (deviation IQ)
— the Wechsler tests for adults, children, and young children, measures verbal and performance skills, caution when using cross-culturally

Question 17

Neuropsychological testing

Answer 17

— assess his brain disfunction by observing its affects on the persons ability to perform certain tasks
— measures receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, learning and abstraction
— used as screening devices, and are paired with other assessments to avoid false positives and false negatives
— valid measure of detecting organic damage and cognitive disorders
— Bender visual-motor gestalt test: Simple screen instrument for children, children copy what is drawn on a card, if there are too many errors brain dysfunction is suspected
— Halstead-Reitman Neuropsychological Battery: Rhythm test: sound recognition, attention, concentration
Strength and grip test: compares grip
Tactile performance: learning and memory

Question 18

Neuroimaging

Answer 18

— pictures of the brain structure and function.
— brain imaging holds enormous potential for illuminating the contribution of neurobiological factors to psychological disorders
— attempting to discover neurological (biological) markers of specific psychological disorders or traits associated with them
1. Brain structure: cat scans - quick, noninvasive, x-radiation poses risk of cell death, can locate tumours, injuries, abnormalities. MRI - more precise, layers, more expensive and time consuming, enclosed, Starting to be used to associate abnormalities to psychological disorders
2. Brain function: measures function of the brain instead of structure.
—Positron emission tomography (PET): Used to look at varying patterns of glucose metabolism that might be associated with different disorders, very expensive, 32-120 minutes, Uses imagery in tracer, target specific function, localizes areas, super imposed on MRI or CT scan
— single photon emission computed tomography: similar to PET, Different tracer, less expensive, less accurate, used more frequently
— functional magnetic resonance imaging (fMRI): Shows function, works quicker than MRI, event related fMRI can see immediate response of the brain to a brief event, largely replacing PET scans in leading brain imaging centres

Question 19

Psychophysiological assessment

Answer 19

— assess his brain function, structure, and nervous system activity
— assessing psychophysiological responding to emotional stimuli is very important in many disorders like PTSD
1. Electroencephalogram (EEG): Measures electrical activity in the brain, brain waves can be assessed awake or asleep, Patterns can be recorded in response to a psychologically meaningful stimulus called event-related potential or evoked potential, Primary diagnostic tool for seizure disorders
2. Electrodermal responding: Formally galvanic skin response, measures sweat glands, heart rate, respiration
3. Biofeedback: levels of physiological responding fed back to patients they can try to regulate them, useful for headaches, high blood pressure

Question 20

Diagnosing psychological disorders

Answer 20

— classification: Refers 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: classification in a scientific context
— Nosology: application of taxonomic system to psychological or medical phenomena
— Nomenclature: names or labels of disorders that make up a nosology
— DSM-5: North America: mental disorders
— ICD-11: international: diseases, health related problems

Question 21

Classification approaches

Answer 21

1. Categorical: comes from the biological tradition and Emil Kraeplin,
   Good for medical field not psychological field, each disorder is separate and has clear underlying cause
2. Dimensional: note variety of cognitions, moods, and behaviours with which the patient presents and quantify them on a scale (e.g. 1-10), Usually applied a personality disorders, theorist can’t decide on how many dimensions (1-33)
3. Prototypical: DSM-5 is based on this approach, identify certain essential characteristics of an entity so we can classify it, but it also allows for certain nonessential variations that do not necessarily change the classification, boundaries between disorders can become fuzzy, has advantage of fitting better with current knowledge of psychopathology, relatively user-friendly, patients must meet some, but not all, of the criteria for disorder

Question 22

Reliability

Answer 22

Degree to which a measurement is consistent over time or among different raters
— types of reliability: inter-rater, test-retest, inter- method, internal consistency

Question 23

Validity

Answer 23

Whether something measures what it is designed to measure

— types of validity: construct (convergent, discriminate), content, criterion (concurrent, predictive)