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PSYC340 > Chatper 3 - Clinical Assessment > Flashcards

Chatper 3 - Clinical Assessment Flashcards

1
Q

Clinical assessment

A

Systematic gathering of info about a person in relation to his/her environment to inform decisions regarding his/her care

Evaluation/measurement of social, biological, and psychological factors

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2
Q

Goals of clinical assessment

A
  1. Classification (diagnosis)
  2. Description (also make sure that the client understands diagnosis)
  3. Planning (of the treatment)
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3
Q

Name the components of the 1st assessment interview (client history)

A 
Demographic
Chief complaint
Previous treatments
Family backgrounds
Health background
Social history (risk/protective factors)
Occupational history
Developmental history
Strengths
Current treatment goals
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4
Q

Name the parts of the physical examination in assessment

A

General physical
Neurological (anatomical and functional measures)
Neuropsychological

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5
Q

2 parts of the neurological examination

A
  1. Anatomical (structural - when brain is not working much): CAT and MRI
  2. Functional (when brain is working): PET, fMRI and EEG
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6
Q

Pros and Cons of CAT scan

A

Computerized axial tomography
Relatively inexpensive and available
Use of X rays
Low spatial resolution

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7
Q

Pros and Cons of MRI

A

Magnetic Resonance Imaging
Higher spatial resolution than CAT
Not appropriate for all individuals (claustrophobia, implants or etc)
More expensive than CAT

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8
Q

Pros and Cons of PET

A

Positron Emission Tomography
Low spatial and temporal resolution (unclear pic)
Invasive (tracing solution)

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9
Q

Pros and Cons of fMRI

A

Functional Magnetic Resonance Imaging

Higher spatial and temporal resolution than PET

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10
Q

Pros and Cons of EEG

A

ElectroEncephaloGraphy

Low spatial resolution

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11
Q

Neuropsychological examination def - types of batteries

A

Deficits in functioning are associated with damage to specific areas of the brain (goal of this part of assessment - assess brain damage and its impact on functioning)
Can use fixed or flexible batteries
Cognitive abilities are assessed and compared to demographically matched norms

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12
Q

Psychophysiological Assessment

A

Activities of the ANS are frequently assessed by electrical and chemical measurements in attempt to understand the nature of emotion
EX: heart rate and skin conductance measures

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13
Q

Heart rate measured with

A

electrocardiogram

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14
Q

Skin conductance measured with

A

electrodermal responding

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15
Q

Neurochemical assessment example

A

Analyzing the metabolites of neurotransmitters that have been broken down by enzymes - looking at the residue of neurotransmitter use in order to determine why/where is the imbalance in neurotransmitters present (can also be analyzed with the blood)

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16
Q

Biofeedback

A

People know/see their biological measurement (heart rate, etc) and become able to control it through therapy

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17
Q

Components of psychosocial assessment

A 
Behavioural assessment
Clinical interviews
Psychological tests
Speaking to Other Professionals (respect confidentiality)
Speaking to Other ppl in patient's life
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18
Q

Behavioural assessment types

A 
Naturalistic observation (watch client in their environment - bias)
Controlled observation (ex: role playing - aka analogue situations)
Rating scales (observer or self-report)
Self-monitoring (adults - ex: beeper)
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19
Q

Pros and Cons of behavioural assessment

A

Focus on the behaviours relevant to treatment
Diverse techniques
Quantifiable way to measure progress
Observations can be biased and time consuming
Self-report induces desirability issues

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20
Q

Clinical Interview characteristics

A
  • Face-to-face verbal exchange (over phone or online also possible but not the same)
  • Goal-directed (ex: assess for a diagnostic)
  • Structured or unstructured (aka semi-structured)
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21
Q

Structured clinical interview

A

Specific questions
Specific directions (flow chart)
Aimed at diagnosis
Ex: Structured Clinical Interview for DSM

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22
Q

Unstrutured Clinical Interview (compared to structured)

A 
More flexible
More sensitive (gain + info bc you let the client elaborate, which leads to other questions)
Less reliable (influence of paradigm, not replicable, prone to observer's bias)
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23
Q

2 types of psychological tests

A

Intelligence and Personality tests

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24
Q

3 Examples of Intelligence tests

A

Stanford-Binet Intelligence Scale
Wechsler Adult Intelligence Scale (WAIS)
Wechsler Intelligence Scale for Children (WISC)

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25
Q

Pros and Cons of intelligence tests

A

Norms have been established over many tests, so it increases their reliability
Has to be put in context to have practical/significant use

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26
Q

Subscales of WAIS

A
  • Verbal: vocabulary, similarities, arithmetic, digit span, information, comprehension, letter-number sequencing
  • Performance: picture completion, digit-symbol coding, block design, matrix reasoning, picture arrangement, symbol search, object assembly

*Can be done as neuropsych tests, because some test things like WM

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27
Q

2 types of personality tests

A 
Projective tests (ex: response to ambiguous stimuli)
Objective tests (ex: self-reports)
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28
Q

Personality

A

Collection of traits relatively stable over time in an individual (depends on a combination of factors - family, genetics, experiences, etc)

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29
Q

Are personality disorder episodic?

A

NO - personality = way someone typically deals with the world

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30
Q

Projective tests: characteristics and examples

A 
Characteristics:
ambiguous stimuli
freedom of response
open to interpretations (flaw)
it's coming directly from the patient - allow interpretation similar to art piece
Ex:
Rorschach Inkblot test
Thematic Apperception Test (TAT)
House-Tree-Person
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31
Q

House-Tree-Person test

A

House: how they feel in their environment
Tree: related to emotions/stability/emotional world
Person: represents themselves, as a person

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32
Q

Variation of house-tree-person test

A

Kids asked to draw their family as doing something (seeing family dynamics)

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33
Q

Psychotic patient answer’s to the inkblot test

A

May zoom on 1 small detail, not take full picture

Imagine things that arent there

34
Q

Pros Cons of inkblot test

A

Answers greatly influenced by the current state of the person
highly subjective interpretation

35
Q

Role of colour in inkblot test

A

Colours are connected with emotions; if they are not considered in the response we need to ask why not (Possibility: patient struggles with expressing emotions)

36
Q

Leading questions in Thematic Apperception Test (TAT)

A 
What is happening now?
What led up to this event?
What will the outcome be?
What are they thinking and feeling?
Looking for themes in the person's answers (ex: sad endings, rejection, etc)
37
Q

Defining characteristics of objective tests and examples

A

Group Norms (stats of many ppl compiled)
Well-defined stimuli (compared to projective test - true/false questions rather than interpreting pictures)
Quantitative responses
Easy administration and scoring

Ex: NEO personality inventory (NEO-PI), Minnesota Multiphasic Personality Inventory (MMPI-2)

38
Q

What is the NEO-PI based on?

A 
OCEAN - 5-factor model to personality
Openness to experience: inquiring intellect
Conscientiousness: dependability
Extraversion: sociability
Agreeableness: friendly compliance
Neuroticism: emotional stability
39
Q

Characteristics of MMPI-2

A

567 t/f questions
Based on normative sample of 2600 adults and clinical samples (in and outpatients)
10 clinical scales: empirical keying (certain disorder), compared to normative rates of responding - to identify precise disorders
Validity scales - to detect patterns of unreliable/biased responding

40
Q

Why would someone lie on the MMPI-2?

A 
Social desirability (don't want to appear sick(
Trying to get attention/services
41
Q

Name MMPI-2 Clinical Scales

A
  1. Hypochondriasis (excessice concern with body functions)
  2. Depression (pessimism, hopelessness, slowing of thoughts/behaviours)
  3. Hysteria (somatoform disorders; physical manifestations but with psychological cause - to avoid conflicts or responsibility)
  4. Psychopathic deviate (disregard of customs, shallow emotions, inability to profit from experience)
  5. Masculinity-femininity (obsolete - not useful for gender dysphoria)
  6. Paranoia (abnormal suspiciousness, delusions of grandeur/persecution)
  7. Psychasthenia (obsessions, compulsiveness, fears, guilt, indecisiveness - linked with OCD)
  8. Schizophrenia (bizarre/unusual thoughts/behaviours, withdrawal, hallucinations, delusions)
  9. Hypomania (emotional excitement, overactivity - component of bipolar disorders)
  10. Social introversion (shyness, disinterest in others)
42
Q

Psychometrics

A

Field of study concerned with theory and technique of psychological measurement, the constructions of instruments and procedures for measurement

43
Q

Reliability

A

Degree to which a measuring instrument produces the same result each time it is used to measure the same thing (consistency of the measurement)

44
Q

Inter-rater reliability

A

Degree to which 2 raters arrive at the same conclusions

45
Q

Test-retest reliability

A

Stability of measures over time

46
Q

Transient disorders

A

symptoms will be there 1 day but not the other (influences reliability)

47
Q

Validity

A

Degree to which a test/assessment measures what it is intended to measure

48
Q

Construct Validity

A

Are we measuring the construct of interest? Are the items really measuring the construct we intend to measure?

49
Q

Criterion validity

A

Correspondence to external criterion or standard
Is the measurement you get related to the construct you want to measure for real? Ex: take someone who definitely has the disorder and compare it with someone suspected to have it; are their results comparable?

50
Q

Concurrent validity

A

Compare results of different measures intended to measure the same construct
EX; is the criteria “skin conductance” related to whatever other measure of anxiety? There should be something you’re adding with this new measure

51
Q

Predictive validity

A

Should be able to predict something ELSE in the future with our measurements; ex: depression being an indicator for suicidal ideation

52
Q

Face validity

A

Are the items on the questionnaire LOOKING like they are related to the construct? With logic/intuition
Could have ONLY face validity and no other type - would indicate a bad study

53
Q

Reliable but not valid?

A

Getting the same results over time, but not actually measuring what is intended

54
Q

Valid but not reliable?

A

Measuring the right thing but results are not consistent over time (might have a measure very sensitive to transient symptoms - that are not permanent)

55
Q

Mental status examination - what is it?

A

quick and dirty way to make an assessment (ex: useful for ER evaluation) - always a physical before this if they came in the ER
Way to get a lot of info very quickly
Goal: understand what that person needs in order to determine where they should go after
Inpatient care?
Neurological consult?
Sent home?

56
Q

Mental status examination components

A

General description (appearance, psychomotor behaviour, attitude towards examiner)
Mood and affect (how they feel generally)
Speech
Perceptual disturbances (do they hear/see stuff that we can’t?)
Thought (oriented to person, place, time, process - do they know who/where they are?)
Judgement and insight

57
Q

Alternate-form reliability

A

using 2 forms of a test rather than the same test twice (to avoid ppl remembering answers)

58
Q

Internal consistency reliability

A

whether the items on a test are related to one another (ex: we expect the items of an anxiety survey to be correlated with one another if they truly assess anxiety)

59
Q

Content validity

A

the extent to which a measure adequately samples the domain of interest

60
Q

Case validity

A

the validity of the interpretations and decisions made with respect to a particular person (ex: accurately assessing a disorder to someone)

61
Q

Reliability of clinical assessment (unstructured interview)

A

Since an interview is unstructured and the clinician relies on experience and intuition, it has low reliability (2 clinicians will come to different conclusions)
The info will be corrected in the following sessions with the client

62
Q

Problems in the current assessment practices (what led people to push for evidence-based assessment)

A

Proliferation/predominance of unstructured clinical interviews (low reliability and validity)
Suggestions that very low numbers of clinicians adhere to best practice assessment guidelines
Relatively rare use of assessment in formal treatment monitoring by clinicians

63
Q

Standardization

A

results of tests are analyzed to see how certain types of ppl tend to respond, in order to establish statistical norms

64
Q

Test norms

A

standards used to interpret an individual’s score (comparison context) - usually mean scores and variability scores

65
Q

Fake Bad Scale in MMPI-2

A

Renamed the Symptom validity scale and unusable in court - extent to which the answers make sense

66
Q

Uses of intelligence tests

A

To diagnose LD, in conjunction with achievement tests (and assess strength/weaknesses for academic planning
To determine the presence of intellectual disability
Identify intellectually gifted chilren
As part of neuropsych evaluations (ex: with dementia patients)

67
Q

Controversy + solution about racial/cultural differences in intelligence testing

A

Black ppl have scores lower of abt 15 pts
Has been associated with genetic factors, but in fact it could be due more to environmental
Stereotype threat: test scores fluctuates out of concern that they will be used to reinforce stereotypical ideas
Aboriginal ppl: is it biased to apply to them the same norms as the general population?
Inuit children had significantly low scores on verbal scale, mainly bc of poor comprehension of the English language (77% had a less than 70 score for verbal scale, while only 5.7% had a less than 70 score for overall test)

One solution: rely on race norms (norms that were revised for cultural/racial groups)
68
Q

Cognitive-Behavioural Case Formulation

A

map of a person’s presenting problems that describes the territory of the problems and explains the processes that caused and maintained the problem
Allows for + individualized treatment
Formulations: possible causes for certain problems (influence treatment)

69
Q

5 components of the Behavioural and Cognitive Assessment and Case Formulation
approach

A
  1. Problem List (Difficulties the clients is having in various domains (psych, developmetns, interpersonal, occupational, medical, housing, financial, legal, leisure))
  2. Diagnosis (Included because it can leaf to initial hypotheses about how to formulate the case and provide info about possible interventions)
  3. Working Hypothesis (“Mini theory” of the case: suggests relations among the problems (clinician tells a story of the person’s problems))
  4. Strengths and Assets (Info about patient’s strengths; can help to develop the hypothesis and define goals/treatment)
  5. Treatment Plan
    (Has 6 components
    1. Goals - crucial
    2. Modality
    3. Frequency
    4. Initial interventions
    5. Adjunct therapies
    6. Obstacles - crucial)
70
Q

SPECT scan (physical examination)

A

(single photon emission computerized tomography): assesses blood flow to the brain

71
Q

Neurologist

A

physician who specialized in medical diseases that affect the nervous system (ex; cerebral palsy, muscular dystrophy, Alzheimer’s)

72
Q

Neuropsychologist

A

psychologist who studies how dysfunctions of the brain affect the way we think, feel, and behave

73
Q

Goals of neuropsychological testing

A

Measure in an accurate way the behavioural correlates of brain functions
Identify characteristic profile of neurobehavioural syndromes
Establish possible location, etiology of a brain lesion
Determine if neuropsychological deficits are present regardless of diagnosis
Describe neuropsychological strengths, weaknesses and strategy of problem solving
Assess the patient’s feelings’ about their syndrome
Provide treatment recommendations

74
Q

Luria-Nebraska battery (neuropsych test)

A

269 items assessing general brain functions
Administered in 2.5 hrs
Reliable and valid
Believed to pick up effects of brain damage where neurological examination cant
Can be controlled for educational levels
Children’s version useful for brain damage in children

75
Q

Describe canadian research on neuropsych

A

Neurobehavioral research with focus on memory and frontal-lobe functions (Donald T. Struss)
Rourke - U of Windsor - research on non-verbal methods for the neuropsych assessment of children and adults with LD
Study on effects of dementia on the Canadian society (Canadian Study of Health and Aging) - neuropsychological battery administered in 1hr
Zakzanis and colleagues: put together profiles of test sensitivities for types of dementia (to help clinicians)

76
Q

Psychophysiology

A

concerned with the bodily changes that accompany psychological events or that are associated with a person’s psychological characteristics
Ex: heart rate, muscle tension, blood flow, etc are measured, as well as brain waves
Not sensitive enough for diagnosis, but can provide important info

77
Q

Case example of Ernest H (importance of diagnosis)

A

Demographics:
35 y.o.
Cop from Winnipeg
Went to university

Problems
	Erectile dysfunction (substance-use based)
	Mood swings (bipolar disorder I)
	Alcoholism
	Avoidant Personality Disorder
	Difficult relationship with spouse

History
Unhappy childhood
Mother died suddenly
Alcoholic father - variable moods (manic-depressive psychosis)
Poor - father income was irregular
Psych problems started in uni
Depressive episodes - followed by manic episodes
Self-conscious with ppl of authority
Met Judy, his wife - married quickly (doubted how she could love someone like him)
Entered police academy, did not believe he was skilled enough to go to law school
Hoped it would gain other’s respect
Wife quit uni to help pay his school
Mood swings - drank to help
Tried having children at 32
Impotence problems started
Could not believe his wife truly loved him
Alcohol problems worsen and attacked his wife

Diagnosing is difficult, but crucial in giving the right treatment
We base our decisions on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

78
Q

Importance of diagnoses - according to Joel Paris

A

Research: can advance research
Clinical practice: can guide treatment and understanding of the disorder
Pharmaceutical industry: what is its role in the classification? Profit?
Legal system: biases/inadequacies in how disorder is determined can get reflected in legal decisions
Public; does the classification relate to general beliefs about mental disorder among people in general

79
Q

Race norms

A

norms that were revised for cultural/racial groups

80
Q

Stereotype threat

A

Scores fluctuate out of concern about how the information will be used according to stereotypical perceptions about a certain ethnic group

81
Q

Projective hypothesis

A

“The notion that highly unstructured stimuli, as in the Rorschach inkblot test, are necessary to bypass defences in order to reveal unconscious motives and conflicts.”

PSYC340 (14 decks)

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