Chapter 4 Flashcards
Psychological assessment
Refers to procedure by which clinicians, using psychological tests, observation and interviews, develop summary of clients symptoms and problems. Ongoing process, may be important at various points of treatment.
Clinical diagnosis
Process through which clinician arrives at general summary classification of patients symptoms by following clearly defined system such as dsm-5 or icd-10 (international classification of disease, published by who)
Function of pretreatment assessment
- Initial assessment, attempt is usually made to identify main dimensions of problem and predict probably course of events under various conditions to make crucial decisions (treatment, hospitalization, inclusion of family members).
- establishing baselines for various psychological functions so effects of treatment can be measured. Criteria based on these measurements may be established as part of treatment plan.
- comparison of pretreatment assessment results with post treatment results
Presenting problem
Major symptoms and behaviour client is experiencing. First thing clinician needs to find out
Why is it important to have adequate classification of presenting problem?
Knowledge of persons type of disorder can help in planning and managing appropriate treatment.
Essential to know range of diagnostic problems that are represented in client population and to determine which treatment facilities need to be available.
Formal diagnosis usually needed before insurance claims can be filed to cover client treatment costs
Other than diagnostic label, what else does adequate assessment include?
Clear understanding of individuals behavioural history, intellectual functioning, personality characteristics, and environmental pressures and resources. Excesses, deficits, and appropriateness are key dimensions to be noted
Assessment and personality factors
Assessment should include description of any relevant long term personality characteristics
Assessment and social context
Assess the social context in which the individual functions. What type of demands are placed on them and what supports or special stressors exist in their situation?
Dynamic formulation
“Picture” of client that integrates diverse and often conflicting bits of information about individuals personality traits, behaviour patterns, environmental demands etc.
Describe current situation and includes hypotheses about what is driving person to behave in maladaptive ways. It should allow clinician to develop hypotheses about clients future behaviour also
Decisions about treatment
Where feasible, decisions about treatment are made collaboratively with consent and approval of individual. When disorder is severe, decisions may have to be made without clients participation or sometimes without consulting responsible family members. This is where knowledge of clients strengths and resources are important. May involve coordinated use of physical, psychological and environmental assessment procedures
Cultural competence
Critical for psychologists to be informed of issues involved in multicultural assessment and to use testing procedures that have been adapted and validated for culturally diverse clients. To fairly consider such individuals, consider various test factors, test taking abilities and other characteristics of person being assessed (such as situational, linguistic, and cultural differences) that might affect their judgments or reduce accuracy of their interpretations
What do psychologists who use tests in culturally competent manner need to bear in mind?
A range of issues and factors involved with culturally and linguistically diverse clients. Issues involve importance id ensuring test being employed is appropriate across cultures and that potential biasing factors do not interfere with critical thinking in overall assessment process
Challenges of understanding clients when performing multicultural assessments
Involve both test instrument characteristics and sociocultural factors such as relationships among culture, behaviour and psychopathology. Psychologists need to ensure that test procedures they employ are autorotate for particular client. Meaning and cultural significance of test items should be similar across cultural groups and norms used to compare client should be appropriate. In using western developed tests, need to take into account dominant language, socioeconomic status, ethnicity and gender of clients (when using translated version, be aware of possible differences that may arise). Need to be aware of available research on using that instrument with target population. Need to be concerned with impact and fairness of instruments they employ with clients from diverse groups
MMPI-2 in diverse populations
Minnesota Multiphasic personality inventory has been widely evaluated both in international applications with translated versions and in diverse subcultural groups in USA. Spanish language versions of test have been developed. Support for use of MMPI-2 with minorities
Reliability
Describing degree to which an assessment measure produces same results each time it is used to evaluate same thing. Index of extent to which measurement instrument can agree that persons behaviour fits given diagnostic class. If observations are different, may mean that classification criteria are not precise enough to determine whether suspected disorder is present
Validity
Extent to which measuring instrument actually measures what it is supposed to measure. Degree to which measure accurately conveys to us something clinically important about person whose behaviour fits the category, such as helping to predict future course of disorder. Normally presupposes reliability. But good reliability does not in itself guarantee validity
Standardization
Process by which psychological test is administered, scored, and interpreted in consistent or standard manner. Standardized tests considered to be more fair than nonstandardized tests in that they are applied consistently and in same manner to all persons taking them. Many psychological tests are standardized to allow comparison with reference population/normative sample.
T score distribution
Comparing particular individuals test score on distribution of test scores from large normative population can enable user to evaluate whether individuals score is low, average, or high along distribution of scores
Relationship between client and clinician
Client must feel comfortable with clinician. Client just feel that testing will help practitioner gain clear understanding of problems and how they will be incorporated into clinical evaluation. Clinician should explain what will happen during assessment and how info will be used. Clients need to be assured that feelings , beliefs, attitudes and personal history being disclosed will be used appropriately and kept in confidence
Where person is being tested for third party such as court system
Referring source is third party (court/judge) not individual being tested. Testing relationship is likely to be strained and test taking behaviour is likely to be different; interpretation of test needs to reflect different motivation created by unwillingness to cooperate
What happens when patients are given appropriate feedback on test results?
They tend to improve, just from gaining perspective on problems as result of testing. Can be powerful clinical intervention. Can also increase self esteem as result of having clearer understanding of their own resources
Physical examination
May be part of evaluation when physical symptoms are part of presenting clinical picture. Consists of kind of procedures in a medical checkup. Medical history is obtained and major systems is body are checked. Important for disorders that entail physical problems such as psychologically based physical conditions, addictive disorders and organic brain syndromes, as well as variety of organic conditions that can produce behavioural symptoms due to hormonal irregularities. Also sometimes long lasting pain results from emotional factors
Electroencephalogram (EEG)
Assesses brain wave patterns in awake and sleeping patients. Graphical record of brains electrical activity. Obtained by placing electrodes on scalp and amplifying brain wave pulses from various brain areas, which moves oscillating pens on a strip of paper. Divergences from normal pattern reflect abnormalities in brain function that might be caused by brain tumour or lesion. May also reveal dysthymia in brains electrical activity, then other techniques can be used to look for more precise diagnosis
Dysthymia
Irregular pattern
Computerized axial tomography (CAT) scan
Specialized radiological technology. Through use if x-rays, cat scan reveals images of parts of brain that might be diseased. Provides rapid access, without surgery, about localization and extent of anomalies in brains structure. Uses X-ray beams across sections of patients brain to produce images that neurologist can interpret
Magnetic resonance imaging (MRI) vs cat scan
Produces sharper images of interior of brain than cat scans because of ability to differentiate subtle variations in soft tissue. Normally less complicated to administer than cat scan and doesn’t subject patients to ionizing radiation.
MRI
Involves precise measurement of variations in magnetic fields caused by varying amounts of water content in various organs and parts of organs. Makes possible visualization of all but most minute abnormalities of brain structure. Useful in confirming degenerative brain processes
Problems with MRI
Some patients have claustrophobia to being placed in MRI machine. Current beliefs about MRI draw on cultural ideas about technology and are reinforced by health care policies and insurance reimbursement patterns. Studies have concluded that MRI studies do not always lead to better outcomes for patients
Positron emission tomography (PET) scan
Allows for appraisal of how an organ is functioning. Provides metabolic portraits by tracking natural compounds such as glucose as they are metabolized by brain and other organs. Enables medical specialists to obtain more clear cut diagnoses of brain pathology by pinpointing sites responsible for each problem. May be able to reveal problems that are not immediately apparent anatomically. May also aid in important discoveries about organic processes underlying disorders and aid in treatment
Limitations of pet scans
Limited value because of low fidelity pictures obtained and their cost. Some investigators recommend questioning their use in forensic evaluations
Functional MRI (fMRI)
Most often measures changes in local oxygenation (blood flow) of specific areas of brain tissue that in turn depends on neuronal activity in those specific regions. Ongoing psychological activity can thus be “mapped”, revealing specific areas of brain that appear to be involved in neurological process. Required development of high speed devices for enhancing recording process, and computer analysis of incoming data - improvements likely to lead to increase in studying using functional imaging. Thought by some to hold more promise for depicting brain abnormalities than currently used procedures such as neuropsychological examination
What have studies using fMRI shown?
Explored cortical functioning that underlies various psychological processes. Some researchers have pointed out that fMRI had high potential for contributing to treatment approach in mental health care. But fMRI has been ruled against as lie detector. FMRI technique has potential of adding to our understanding of early development of psychological disorder
Aphasia
Disorder in which there in loss of ability to communicate verbally
Methodological limitations of fMRI
Both MRI and fMRI are sensitive to instrument errors or inaccurate observations as result of slight movements of person being evaluated. Results of fMRI studies difficult to interpret. Results don’t often provide much specific info about processes studied.
Primary value of fMRI currently
Research into cortical activity and cognitive processes, though shows promise for understanding brain functioning
Neuropsychological assessment
Involves use of various testing devices to measure persons cognitive, perceptual and motor performance as clues to extent and location of brain damage. Such testing may even provide clues to probable location of brain damage, though other tests may be more effective in determining exact location of injury
Individualized tests vs standardized tests
Neuropsychologists may prefer to administer individualized tests or a standard set of tests that have been preselected to sample a broad range of psychological competencies known to be adversely affected by various types of brain injury. Use of constant tests has advantages, though may compromise flexibility
Halstead-Reitan neuropsychology test battery
Composed of several tests and variables from which “index of impairment” can be computed. Also provides specific info about subjects functioning in several skill areas. Made up of a group of tests such as: Halstead category test Tactual performance test Rhythm test Speech sounds perception test Finger oscillation task
Halstead category test
Measures subjects ability to learn and remember material and can provide clues as to their judgment and impulsivity. Subject is presented with stimulus that suggests number between 1-4. Subjects presses button indicating number they believe it is suggesting. Correct choice is followed by sound of doorbell, incorrect by buzzer. Person must determine pattern from series of doorbells and buzzers for what correct choice is
Tactual performance test
Measures subjects motor speed, response to unfamiliar, and ability to learn and use tactile and kinaesthetic cues. Test surface is board that has space for 10 blocks if varies shapes. Subject is blindfolded and asked to place blocks into correct grooves in board. Later, asked to draw blocks and board from tactile memory
Rhythm test
Measures attention and sustained concentration through auditory perception task. Includes 30 pairs of rhythmic beats presented on tape recorder, subjects asked whether pairs are same or different
Speech sounds perception test
Determine whether individual can identify spoken words. Nonsense words are presented on tape recorder and subject is asked to identify presented word in list of 4 printed words. Task measures subjects concentration, attention and comprehension
Finger oscillation task
Measures speed at which individual can depress lever with index finger. Several trials are given for each hand
What does psychosocial assessment attempt to provide?
A realistic picture of an individual in interaction with their social environment. Includes relevant info about personality, present level of functioning, and info about stressors and resources in life situation. Clinicians typically form hypotheses and discard or confirm them as they proceed. Ex of psychosocial procedures are: assessment interviews, clinical observation of behaviour, and psychological tests
Assessment interviews
Often considered central element of assessment process, usually involves face to face interaction where clinician obtains info. May be simple or detailed, may be open in character or more tightly controlled and structured
Structured vs unstructured interviews
Research data shows more controlled and structured interviews yields more reliable results than flexible format
Structured interviews
Predetermined set of questions throughout interview. Beginning statements and introduction to interview follow set procedures. Themes and questions are predetermined to obtain particular responses for all items. Interviewer cannot deviate and all questions are asked in purest way.
Negatives if structured interviews
Typically take longer to administer and and may include seemingly tangential questions. Clients can sometimes be frustrated by overly detailed questions in areas that are of no concern to them
Unstructured assessment interviews
Subjective, do not follow predetermined set of questions. Beginning statements are usually general and follow up questions are tailored for each client. Content is influenced by habits or theoretical views of interviewer, where they subjectively decide what to ask based on clients response to previous questions.
Negatives of unstructured interviews
Because questions are asked in unplanned way, important criteria needed for DSM-5 diagnosis might be skipped. Responses are difficult to quantify or compare, thus use in research is limited
Positive of unstructured interviews
Clients may view these interviews as being more sensitive to their needs or problems than more structured procedures. Plus more spontaneous follow up questions that emerge can provide valuable info that would not emerge in structured interviews
Rating scales
Help focus inquiry and quantify interview data. Enhances reliability of assessment interviews. Formal structure of scale is likely to keep observer inferences to minimum. Most useful rating scales allow user to indicate presence/absence of trait and also its prominence or degree. Ex rating scale: brief psychiatric rating scale (BPRS)
Can clinical interviews be subject to error?
Yes, because they rely in human judgment to choose the questions and process the info. Evidence of this comes up when different clinicians arrive at different formal diagnoses on basis of interview data they elicited from client. This is reason why DSM emphasizes operational assessment approach, one that specifies observable criteria for diagnosis and provides specific guidelines for making diagnostic judgements - leads to more reliable psychiatric diagnoses, at increased cost in reduced interviewer flexibility
Racial and ethnic factors when conducting interviews
Interview process and outcome can be substantially influenced by ethnicity of interviewer and client
Purpose of direct observation
Learn more about persons psychological functioning by attending to their appearance and behaviour. Ideally takes place in natural environment, but is more likely to take place upon admission to hospital
Analogue situations
More controlled rather than naturalistic behavioural setting for conducting observations. Designed to yield info about persons adaptive strategies, might involve staged role playing, event reenactment, family interaction assignments, or think aloud procedures
Self monitoring
Self observation and objective reporting of behaviour, thoughts, feelings as they occur in various natural settings. Many clinicians enlist clients help by providing them instructions for this. Can help determine situations in which maladaptive behaviour is likely to occur
