Chapter 3: Clinical Diagnosis and Assessment Flashcards
What are clinical assessments used to determine
appraisal/evaluation:
- solve a mystery/ piece together a puzzles
systematically gathers data:
- objective, subjective
- signs/ symptoms
informs a diagnosis (differential diagnosis)
guides a treatment plan (paradigm/etiology)
definition of diagnosis
When symptoms cluster together in specific patterns a diagnosis is given that identifies the characteristics of a specific disorder
what is etiology
the cause, set of causes, or manner of causation of a disease or condition.
what is a prognosis
a forecast of the likely course of a disease or ailment.
what is prevelance
Prevalence is the proportion of a population who have a specific characteristic in a given time period
what is incidence
number of new cases of a specific disorder that develop during a certain period of time
what is comorbidity
Meeting the criteria for two or more diagnostic categories simultaneously
what is categorical vs. dimensional
categorical: diagnositic criteria defined where abnormality ends and psychopathology begins. DSM retains a categorical system for most diagnoses, but some disorders exist on a continuum
Dimensional: allows a clinician more latitude to assess the severity of a condition and does not imply a concrete threshold between “normality” and a disorder (moves along a continuum)
What does the DSM provide, what was its evolution, and who created it, and who publishes it
The DSM- Diagnostic and Statistical Manual of Mental DIsorders of the American Psychiatric Association (APA). Creates uniformity among diagnostic criteria with high reliability. Emil Kraepelin published the first modern classification system, which our current system is based on
who else has published a classification system for disorders (not DSM)
International Classification of Disease
what is a clinical interview
Clinical interviews: talk with person, must develop report and trust, language is the tool for discovery, ubiquitous (used in every paradigm)
Collect a cheif complaint and compile a detailed history of: persons life, current/past symptoms, social history, medical history, psychological/psychiatric history.
what do structured interviews increase
They increase reliability
what is the content of a structured interview and how are the questions answered
- standardized information
- usually branching (an algorithm)
- questions are prescribed
Clinician asks a series of standardized questions about symptoms and uses concrete criteria to score responses. Benefit: standard and reliable
Draw back: lack ability to ask client specific questions
In interviews, in what instances does and patient self-report and when is the information obtained from someone else
a client is asked to self report in a symptom questionnaire. Information may be obtained from someone else (like a parent) when another perspecitve could benefit the diagnoses.
How do interviews find significances in diagnoses
interviews help cliniciand to determine whether the client’s symptoms qualify for a diagnosis.
what are factors that might influence interviews (gender or age)
- cultural factors
- symptom presentation
- young children can’t properly identify emotions or feelings.
does the patient try to make themselves look like they feel better or worse than they actually do
patients tend to want to present themselves in a better light, especially if it is a legal/custody case
what is malingering
exaggerate or feign illness in order to escape duty or work
what would a doctor from the psychodynamic perspective try to uncover in an interview
They would try to uncover errors in the unconscious causing abnormalties.
Focus on projective tests
interview about problems and childhood
free association
hypnosis
Rorsarch and TAT
stimulus response- top down
what would a doctor from the cognitive/behavioral paradigm try to discover in an interview
- WPPSI/WISC-III/WAIS
- subscales on the Wechsler (WAIS) 1949
- Verbal: general information, similiarities, vocabulary, comprehension, arithmetic reasoning, digit span
- interview and self report questionnaire
- DAS: dysfunctional attitude scale
- ATSS: articulated thought in simulated situations: opened ended, talking/thinking out loud while role playing in pretend situations
what would a doctor from the biological paradigm try to uncover in an interview
also neuroscience perspective
- neurophysical tests: functional battery of tests to pick up dysfunction of specific brain areas, tactile performance (time/memory), category tests, speech sounds/perception
- ECG: electrochardiogram- heart rate
- GSR: galvanic skin resistance - sweating
- EMG: electromyogram- muscle tension
- EEG: electroencephalogram- brain waves
- EP, ERP: evoked potentials- special EEG
what do we obtain observations of in an interview
appearance and behavior (emotions, movement, speech, mental processes)
what does culture do in a clinical setting
place behavior and symptoms in context
what are personality assessment inventories
MMPI: pathology/disorders:
- multiphasic: asses for multiple disorders at once
MACI
- adolescents who may be acting out
MCMI (Million)
- personality disorders
Myers Briggs
what does the MMPI-2 assess
assess for multiple disorders at once
has 4 validity scales and dysfunction of personality scales” ?: cant say, L: lie trying to look good, F: infrequency trying to look abnormal, K: guarded or defensive, avoid looking incompetent
what are the ten subscales of the MMPI-2
Scale 1: hypochondriasis: excessive somatic concern and physical complaints
2: Depression: symptomatic depression
3: Hysteria: hysterical personality features and tendency to develop physical symptoms under stress
4: pyschopathic deviate: antisocial tendencies
5: masculinity-feminity: sex-role conflict
6: paranoia: suspicious, paranoid thinking
7: pyschasthenia: anxiety and obsessive behavior
8: schizophrenia: bizarre thoughts and disordered affect
9: hypomania: behavior found in mania
0: social introversion: social anxiety, withdrawal, overcontrol
what are the ?LFK scales
?: unanswered
L: lie, trying to look good
F: infrequency, trying to look abnormal
K: guarded or defensive, trying to look normal
Used in MMPI
what does the neuropyschological perspective do
use special psychological tests to make inferences about brain function
- test visual perception
- integration of visual and motor function
- organizational ability and memory
- some test judgement and planning while others assess specific abilities such as recognizing something by touch, or ability to recognize faces
how does psychoanalytic/psychodynamic paradigm asses clinical diagnoses
- interview
- free association
- hypnosis
- dream analysis
- projective tests: inkblot and TAT
how does behavioral paradigm assess clinical diagnoses
- interview
- SORC/ABC
- ABA
- EMA
- direct observation and self reports
how does the cognitive paradigm assess clinical diagnoses
- interviews
- DAS
- ATSS
- IQ
- BDI- beck depression inventory is an effective inventory
How does the biological paradigm assess clinical diagnoses
- interview
- brain imaging (CT, MRI, PET, fMRI)
Psychophysiological: EP/ERP, EMG, EEG, ECG, GSR (lie detector), lab tests (treat with drugs, surgery, brain stimulation)
Reliability vs. Validity in clinical assessment
Reliability:
- consistency
- able to repeat findings
- inter-rater
- test-retest
- spilt half, alternate form
- internal (cronbachs alpha)
Validity:
- does it measure what it claims to measure?
- content: adequately sample the domain of interest
- criterion: associated with another variable in an expected way?
- construct: based on a theory?
