Chapter 4- Clinical Assessment And Diagnosis Flashcards
Describe the influence of professional orientation on the assessment process
How clinicians go about the assessment process often depends on their basic treatment orientations.
For example, a biologically oriented clinician, typically a psychiatrist or other medical practitioner, is likely to focus on biological assessment methods aimed at determining any underlying organic malfunctioning that may be causing the maladaptive behaviour.
A psychodynamic or psychoanalytically oriented clinician may choose unstructured personality assessment techniques, such as the Rorschach ink blot’s or the somatic apperception test to identify intrapsychic conflicts or may simply proceed with therapy, expecting these conflicts to emerge naturally as part of the treatment process.
A behaviourally oriented clinician, in an effort to determine the functional relationships between environmental events or reinforcements and the abnormal behavior, will rely on such techniques as behavioural observation and self-monitoring to identify learned maladaptive patterns
For a cognitively oriented behaviorist, the focus was shift to the dysfunctional thoughts supposedly mediating those patterns
Explain what is meant by rapport between the clinician and client, and outline the components of a relationship that leads to good rapport
In order for psychological assessment to proceed effectively and to provide a clear understanding of behaviour and symptoms, the client being evaluated must feel comfortable with the clinician. This means that a client must feel that the testing will help the practitioner gain a clear understanding of her or his problems and must understand how the tests will be used and how the psychologist will incorporate them into the clinical evaluation.
Clients need to be assured that the feelings, beliefs, attitudes, and personal history that they are disclosing will be used appropriately, will be kept in strict confidence, and will be made available only to the therapists or others involved in the case.
Providing test feedback in a clinical setting can be an important element in the treatment process. When patients are given appropriate feedback on test results, they tend to improve, just from getting a perspective on their problems from the testing
Discriminate between structured and unstructured interviews for the assessment of psychosocial functioning, and evaluate the relative merits of the two
Research data show that the more controlled and structured assessment interview you it’s far more reliable results than the flexible format. There appears to be widespread over confidence among clinicians in the accuracy of their own methods and judgements.
Structured interviews follow a predetermined set of questions throughout the interview. Each question is structured in a matter so as to allow responses to be quantified or clearly determined. On the negative side, structured interviews typically take longer to administer than unstructured interviews and may include some seemingly irrelevant questions. Clients can sometimes be frustrated by the overly detailed questions in areas that are of no concern to them.
Unstructured assessment interviews are typically subjective and do not follow a predetermined set of questions. The beginning statements are usually general, and follow up questions are tailored for each client. The content of the interview questions is influenced by the habits or theoretical views of the interviewer.
Because the questions are asked in an unplanned way, important criteria needed for a DSM diagnosis might be skipped. Responses are difficult to quantify or compare with responses of clients from other interviews. On the positive side, unstructured interviews can be viewed by clients as being more sensitive to their needs or problems than more structured procedures.
And approach used to learn more about the person’s psychological functioning by attending to his or her appearance and behaviour in various contexts. It is the clinicians objective description of the person’s appearance and behaviour – his or her personal hygiene and emotional responses and any depression, anxiety, aggression, hallucinations, or delusions she or he may manifest. Ideally takes place in a natural environment, but is more likely to take place upon admission to a clinic or hospital
Clinical observation of behaviour or direct observation
Explain the importance of rating scales in clinical observations
Helps both to organize information and to encourage reliability and objectivity. The formal structure of a scale is likely to keep observer inferences to a minimum. Most useful rating scales are those that enable a raider to indicate not only the presence or absence of a trait or behaviour but also it’s prominence or degree
Describe the major intelligence tests
The Wechsler intelligence scale for children-revised and the Stanford-Binet intelligence scale are widely used in clinical settings for measuring the intellectual abilities of children.
The most commonly used test for measuring adult intelligence is the Weschler adult intelligence scale-revised which includes both verbal and performance material and consists of 15 subtests such as vocabulary and digit span.
Discuss the advantages and disadvantages of projective personality tests
Unstructured tests that rely on various ambiguous stimuli such as inkblots were vague pictures rather then on explicit verbal questions, and the person’s responses are not limited to the true, false, or cannot say variety. Through their interpretations of these ambiguous materials, people reveal a good deal about their personal preoccupations, conflicts, motives, coping techniques, and other personality characteristics.
The assumption is that individuals “project” their own problems, motives, and wishes into the situation. Aimed at discovering the ways in which an individual’s past learning and personality structure may lead him or her to organize and perceive ambiguous information from the environment.
Examples: the Rorschach inkblot test, The thematic apperception test, sentence completion tests
The great strengths of projective techniques – there unstructured nature and their focus on the unique aspects of personality – are at the same time their weaknesses because they make interpretation subjective, unreliable, and difficult to validate. Also typically require a great deal of time to administer and advanced skill to interpret
Discuss the advantages and disadvantages of objective personality tests
Objective personality tests are structured – they typically use questionnaires, self-report inventories, or rating scales in which questions or items are carefully phrased and alternative responses are specified as choices. The involve a far more controlled format then a project of devices and are thus more objectively-based and quantifiable. One virtue of such quantification is it’s precision, which in turn enhances the reliability of test outcomes.
Self-report inventories are cost-effective, highly reliable, and objective; they can also be scored and interpreted by computer.
Something missions consider them to mechanistic to pretrade the complexity of human beings and their problems accurately. And because these tests require the subject to read, comprehend, and answer verbal material, patients who are illiterate or confused cannot take the tests. Also, the individuals cooperation is required in self-report inventories, and it is possible that the person my distort his or her answers to create a particular impression.
Explain the ethical issues involved in assessment (5)
- Potential cultural bias of the instrument or the clinician
- Theoretical orientation of the clinician
- Under emphasis on the external situation: many clinicians overemphasize personality traits as a cause of patients problems without paying enough attention to the possible role of stressors and other circumstances in the patient’s life situations.
- Insufficient validation: some psychological assessment procedures in use today have not been sufficiently validated
- Inaccurate data or premature evaluation
Explain the purpose of classification systems for abnormal behaviour
Classification is important in any science. With an agreed-upon classification system we can be confident that we are communicating clearly.
Classification of some kind is a necessary first step toward introducing order into our discussion of the nature, causes, and treatment of such behavior. Classification makes it possible to communicate about particular clusters of abnormal behaviour in agreed-upon and relatively precise ways.
Allows The gathering of statistics on how common various types of disorders are and meeting the needs of medical insurance companies.
What are the three basic approaches to classifying abnormal behavior?
The categorical, the dimensionalization and the prototypal
This model of classification, like the diagnostic system of general medical diseases, assumes that all human beings are can be divided into the categories of healthy and disordered, and that within the latter there exist discrete, nonoverlapping classes or types of disorder that have a high degree of within-class homogeneity in both symptoms displayed any underlying organization of the disorder identified
The categorical approach
In this approach to classifying abnormal behavior, it is assumed that a person’s typical behaviour is the product of differing strengths or intensities of behaviour along several definable dimensions such as mood, emotional stability, aggressiveness, gender identity, anxiousness, interpersonal trust, clarity of thinking and communication, social introversion, and so on. The important dimensions, once established, are the same for everyone. People are assumed to differ from one another in their configuration or profile of these dimensional traits, not in terms of behavioural indication of a corresponding dysfunctional entity presumed to underlie and give rise to the disordered pattern of behaviour. Normal is discriminated from abnormal in terms of precise statistical criteria derived from dimensional intensities among unselected people in general, most of whom may be presumed to be close to average, or mentally normal
The dimensional approach
In this approach to classifying abnormal behavior, a prototype is a conceptual entity depicting an idealized combination of characteristics that more or less regularly occur together in a less than perfect or standard way at the level of actual observation.
The prototypal approach
The DSM – IV evaluates an individual according to five axes. The first three axes assess and individuals present clinical status or condition, and the last two are used to assess broader aspects of an individual situation. The five axes are:
Axis I: the particular clinical syndromes or other conditions that may be a focus of clinical attention. Includes schizophrenia, generalized anxiety disorder, major depression, and substance dependence. Roughly analogous to the various illnesses and diseases recognized in general medicine.
Axis II – personality disorders: a very broad group of disorders that encompasses a variety of problematic ways of relating to the world. Provides a means of coding for long-standing maladaptive personality traits that may or may not be involved in the development and expression of an axis I disorder.
Axis III- General medical conditions: listed here are any general medical conditions potentially relevant to understanding or managing the case.
Axis IV – psychosocial and environmental problems: this group deals with the stressors that may have contributed to the current disorder, particularly those that have been present during the prior year.
Axis V – global assessment of functioning: this is where clinicians indicate how well the individual is coping at the present time. A 100 point global assessment of functioning or GAF scale is provided for the examiner to assign a number summarizing a patient’s overall ability to function
