Clinical Assessment and Diagnosis Flashcards
What are the four common types of assessments?
Psycho-diagnostic
Psycho-educational
Neuropsychological
Assessment at the beginning of psychotherapy
Assessment to identify and diagnose specific mental disorders (non-cognitive)
Psycho-diagnostic assessment
To identify and diagnose specific learning problems, neurodevelopmental disabilities, and mental health problems (cognitive)
Psycho-educational assessments
Assessing and diagnosing the possible contribution of brain damage or dysfunction to the patient’s condition
Neuropsychological assessments
Assessment when a diagnosis may not be requested or necessary
Assessment at the beginning of psychotherapy
List the seven limits to confidentiality
A person is at serious risk of harming themselves or others
A child is being abused or neglected
Any information about a regulated health profession committing a sexually inappropriate act (reported to that professions college)
Information about a person being neglected in a long-term care home
If a psychologist receives a subpoena from a judge
If the College of Psychologists audits a psychologist’s files
In missing persons investigations when information is requested from authorities
Used to gather relevant information related to the client’s mental health (i.e. presenting problem, demographic information)
Clinical interview
What are the three main types of clinical interviews?
Unstructured interviews
Semi-structured interviews
Structured interviews
Interview style focusing on free speech, not guided
Unstructured interviews
Interview style using a structure that can be naturally built off of to gather more information
Semi-structured interviews
Interview style that’s useful for research but not as common in clinical practice
Structured interviews
Name a pro and con of each main interview style
Unstructured interviews:
Pro - more natural conversation
Con - important information may be missed
Semi-structured interviews:
Pro - information can be gathered both systematically and efficiently
Con - can be challenging to balance flexibility and structure
Structured interviews:
Pro - guarantees all relevant information will be collected; contains specific scoring instructions for disorders
Con - may be overly rigid; may negatively affect relationship with client; time- consuming
What are the five key focuses of a mental status exam?
Appearance and behaviour: Dress, general appearance, posture, and facial expression.
Thought processes: Speech rate and coherence
Mood (described by the individual) and affect (what you notice as the clinician)
Cognitive/intellectual functioning: Any concerns with ability to pay attention, follow the conversation, remember details
Sensorium: Are they oriented to space and time?
Behavioural observations (e.g. mental status exam) are made through direct observation in a specific setting (at school, at home)
Behavioural assessment
The act of measuring a behaviour changes that behaviour
Reactivity
Does the test measure what it is supposed to measure?
Validity
Does the test consistently measure the same thing?
Reliability
What characterizes a good test?
Good validity and reliability
Name the two noted types of validity and give an example of each
Concurrent validity (e.g. one measure of anxiety correlates with other measures of anxiety)
Predictive validity (e.g. intelligence tests correlate with school grades in the future)
Why are projective tests for personality not commonly used in the 21st century?
Questionable validity and reliability
Self-report questionnaires about personality that have been administered to thousands of people (allows for norms)
Personality inventories
Give two examples of personality tests
The Multiphasic Minnesota Personality Inventory (MMPI-2)
NEO-PI
Name and describe the “Big 5” personality traits
Extroversion: socially outgoing and excitement-seeking
Agreeableness: friendliness and compassion
Openness to experience: curiosity and adventurousness
Conscientiousness: organized and systematic
Neuroticism: sensitive and nervous
Give a reason as to why intelligence testing is controversial
There are objections about whether the tests are culturally-appropriate and are valid for people from all backgrounds
Name two types of intelligence tests
WAIS-IV and WISC-V
Name four different types of intelligence that modern tests such as the WAIS-IV and WISC-V assess
Verbal comprehension
Perceptual reasoning
Working memory
Processing speed
What are five areas of cognitive functioning that neuropsychological tests assess?
Receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities
Using self-report measures throughout treatment to measure effectiveness
Outcome monitoring
In the DSM-5 TR, most diagnostic categories…
Assess for the dysfunction and distress associated with mental health problems and whether they are culturally expected
Which characteristics of the symptom are considered when making a diagnosis?
Severity/intensity
Duration
Frequency
A tool that allows us to classify the distinct patterns that characterize mental health problems
Diagnosis
Name the three different approaches to diagnosis
Categorical approach
Dimensional approach
Prototypical approach
A diagnostic approach treating mental disorders as clear categories with a clear physiology and underlying cause
Categorical approach
Name an advantage and a disadvantage of the categorical approach to diagnosis
Advantage: simplicity
Disadvantage: excludes significant numbers of people
Why has the categorical approach to diagnosis largely been abandoned?
Mental disorders are not caused by a single underlying pathology
Diagnostic approach that treats mental disorders as existing on a continuum
Dimensional approach
Name an advantage and a disadvantage to the dimensional diagnostic approach
Advantage: captures the full range of mental health problems
Disadvantage: more challenging to tell when problems become a “disorder”; little agreement on how many dimensions to consider
Diagnostic approach that requires some essential features while also containing flexibility
Prototypical approach
Name an advantage and a disadvantage of the prototypical approach
Advantage: captures a wide range of problems while also keeping categories distinct
Disadvantage: People can present in many different ways
Which diagnostic approach does the DSM-5 use?
Prototypical approach
List five advantages to diagnoses in general
Allows for communication among professionals
Creates some structure and consistency within the healthcare system
Allows us to study specific problems and test specific interventions for those problems
May allow people to access certain services
Can give people a sense of relief
List six disadvantages to diagnoses in general
Certain labels can be stigmatizing
Diagnoses are not entirely objective of thoughts, behaviours, and emotions and they can be wrong
Some labels are persistent (even if they may not be accurate)
A diagnosis implies a disease or pathology
Diagnostic categories have changed over time and are influenced by the current culture
Many mental health problems are co-morbid and overlapping
What does it mean that diagnosis is a “controlled act?”
Only medical doctors and psychologists can diagnose mental disorders in Ontario
Rule stating that “A psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”
Goldwater rule
The process of determining which of two or more diseases or disorders with overlapping symptoms a particular patient has
Differential diagnosis
What are four tricky issues with differential diagnoses?
Equifinality and multifinality
What is “normal”
Understanding overlap across diagnoses
Change/onset/symptom progression
