Clinical Assessment and Diagnosis Flashcards
Gathering information regarding people’s symptoms and the possible causes of these symptoms
ASSESSMENT
• A label for a set of symptoms that often occur together
• process of determining whether the particular problem afflicting the individual meets all criteria for a
psychological disorder
DIAGNOSIS
the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder
CLINICAL ASSESSMENT
– Tools have been developed by clinicians to gather
information
Assessment Tools
•Accuracy of a test to measure what it is designed to measure
Validity
Based from face value, it can measure what it purports
to measure
FACE VALIDITY
Extent to which a test assesses all the important aspects of a phenomenon that it purports to measure
CONTENT VALIDITY
extent to which a test yields the same results as other, established measures of the same behavior, thoughts, or feelings (standard but long vs. brief, new)
CONCURRENT VALIDITY
•good at predicting how a person will think, act, or feel
in the future (IQ—success in school)
PREDICTIVE VALIDITY
•extent to which a test measures what it is supposed to
measure and not something else altogether
CONSTURCT VALIDITY
•Consistency of a test in measuring what it is supposed to measure
Reliability
Consistency of the test results over
time
TEST RETEST RELIABILITY
• Results on a similar version of the test are similar
ALTERNATE FORM RELIABILITY
Similarity in people’s answers
among different parts of the same
test
INTERNAL RELIABILITY
Interjudge Reliability
INTER RATER RELIABILITY
•A way to improve validity and reliability
Standardization
ASSESSMENT TOOLS
- CLINICAL INTERVIEW
- SYMPTOM QUESTIONNAIRES
- BEHAVIORAL OBSERVATIONS AND SELF MONITORING
- PERSONALITY INVENTORIES
- INTELLIGENCE TESTS
- NEUROPSYCHOLOGICAL TESTS
- BRAIN IMAGING TECHNIQUES
- PSYCHOPHYSIOLOGICAL TESTS & PHYSICAL -EXAMINATION
- PROJECTIVE TESTS
Much of the information is gathered through an initial interview
CLINICAL INTERVIEW
Person’s general functioning
MENTAL STATUS EXAM --Appearance and Behavior – Thought Processes • Speech – Mood and Affect – Intellectual Functioning • Memory and Attention – Orientation/Sensorium • Time, place, person, object
– Series of questions asked about a particular symptom that is currently experienced or experienced in the past
– format of the questions and the entire interview is standardized, and the clinician uses concrete criteria to score the person’s answers
Structured Interviews
- made up of questions phrased and tested to elicit useful information
SEMI STRUCTURED INTERVIEW
– have no systematic format
• “Tell me about yourself”
• Start from what is significant to the clinician
Unstructured Interviews
-Pays attention to the medical condition of the client which might cause the psychological problem
-Assessing If a medical condition or substance
abuse is merely coexisting or a casual one
• Rule out or manage conditions which are
exacerbating the condition of the client
– Eg. Hypothyroidism, brain tumor, panic attacks
PHYSICAL EXAMINATION By Physician – Neurodev – Neurologist – Psychiatrist
REMEMBER
Questionnaires can cover a wide variety of
symptoms representing several different disorders
Used for individuals who are not old enough
or skilled enough to report their problems and
experiences
– Individuals with special needs
– Individuals who are physically and psychologically
challenged
– Elders
– Young children
BEHAVIORAL ASSESSMENT
– to assess deficits in skills or ways of handling
situations
– looking for specific behaviors and what precedes
and follows these behaviors
Behavioral Observation
Advantage: not relying on self-reports
– Disadvantage: changing of behavior when
observed; different conclusions/observer
– relies on observer’s recollection
and interpretation of events
Informal
– involves identifying specific
behaviors that are observable or measurable,
having an operational definition
Formal
ABCs of Observation
– Antecedents
– Behavior
– Consequences
– Keeping track of behaviors
Self-Monitoring
– Disadvantage: bias of the individual to report
behaviors
– Advantage: discovery of triggers of certain
behaviors
- Questionnaires meant to assess people’s typical ways of thinking,feeling, and behaving
- Part of an assessment procedure to obtain information on people’s wellbeing, self-concept, attitudes and beliefs, ways of coping, perceptions of their environment and social resources, and vulnerabilities
PERSONALITY INVENTORIES
MMPI – Minnesota Multiphasic
Personality Inventory
– MMPI-2: 567 items
In clinical practice,_____ are used to get a sense of an individual’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected
intelligence tests . Wechsler Adult Intelligence Scale , the Stanford-Binet Intelligence Test , and the Wechsler Intelligence Scale for Children
Useful in detecting specific cognitive deficits such as a
memory problem
• Used when impairment in neurological functioning is suspected
NEUROPSYCHOLOGICAL TEST
Paper-and-pencil
– Bender-Gestalt Test (Bender
Visual Motor Gestalt Test,
BVMGT), Strength of Grip Test
When people attempt to understand an ambiguous or
vague stimulus, their interpretation of the stimulus reflects their needs, feelings, experiences, prior conditioning, thought processes and so forth
PROJECTIVE HYPOTHESIS
People are thought to project these issues onto their description of the “content” of the stimulus
• Useful in uncovering the unconscious issues or motives of a person or in cases when the person is resistant or heavily biasing the information he or she presents to the assessor
PROJECTIVE TEST
– Rorschach Inkblot Test, Thematic
Apperception Test, Sentence
Completion Tests, HTP, DAPT
CHALLENGES IN ASSESSMENT
Resistance – Does not want to provide information • Inability to Provide Information • Assessing Children • Assessing Individuals Across Cultures
It is the tendency for people to accept very general or vague characterizations of themselves and take them to be accurate
BARNUM EFFECT
To identify specific deficits and possible brain abnormalities
• To determine if there is brain injury, tumors, or damage
• Brain Activity and Structure
BRAIN IMAGING
BRAIN IMAGING TECHNIQUES
-COMPUTERIZED TOMOGRAPHY (CT)
Enhanced x-ray procedure
• Brain structure
-POSITRON EMISSION TOMOGRAPHY
Brain activity
• Requires injecting the patient with a harmless radioactive isotope, such as fluorodeoxyglucose
-SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT)
Similar to PET but different tracer substance, lesser accuracy, cheaper
-MAGNETIC RESONANCE IMAGING
• Detailed structure of brain anatomy
• fMRI - functions
alternative methods to CT, PET, SPECT, and MRI used to detect changes in the brain and nervous system that reflect emotional and psychological changes
PSYCHOPHYSIOLOGICAL TEST
– electrical activity along the scalp produced by the firing of specific neurons in the brain
Electroencephalogram (EEG)
•Label that is attached to a set of symptoms that occur together
DIAGNOSIS
SET OF SYMPTOMS
SYNDROME
PROCESS OF DIAGNOSIS
Symptomatic Diagnosis
• Aimed to remove the symptoms
Characterological Diagnosis
• Aimed at identifying the personality dynamics – character
Look into the typical signs and symptoms manifested by the individual
– With the symptoms, one can identify the disorder
SYMPTOMATIC DIAGNOSIS
Look into the personality dynamics, personality, psychodynamics, or behavior dynamics
– Needs, motives – satisfied or unsatisfied
– Conflicts
• Unresolved conflicts
– Fixations
– Coping mechanisms
• Defense mechanisms
Characterological Diagnosis
- Full evaluation of the patient’s personality structure and functioning
- Give emphasis on the specific behavior patterns of the patient
PSYCHODIAGNOSIS
Specific Behavior patterns may be:
ADAPTIVE –
can beutilized in the treatment
MALADAPTIVE –
maylead to mental disorders
PSYCHODIAGNOSIS
Classify the disorder of the patient Do differential diagnosis Psychodiagnostic impression can change Consider other factors such as duration
DIAGNOSIS APPROACH
Idiographic Approach
• Specific to the patient
Nomothetic Approach
• Universal or global
GOALS OF DIAGNOSIS
- Aimed at treatment rather than classification
- Prognosis
- Development of Insight
2 PHASE OF DIAGNOSIS
- DESCRIPTIVE PHASE
• Give a battery of psychological tests
• Interview
• Organogenic vs. Psychogenic
2. INFERENTIAL PHASE • Interpretative Phase • Makinginferences • Making interpretations • Formulating theories
•referring simply to any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations—a nomothetic strategy.
CLASSIFICATION
•which is the classification of entities for scientific purposes
Taxonomy
•applying a taxonomic system to psychological or medical phenomena or other clinical areas
Nosology
describes the names or labels of the disorders that make up the nosology
Nomenclature
Classical Categorical Approach
- Categories
* Criteria
• note the variety of cognitions, moods, and
behaviors with which the patient presents and
quantify them on a scale
• Personality Disorders (Axis II)
Dimensional Approach
• identifies certain essential
• characteristics of an entity so that it can be
classified, but it also allows certain nonessential
variations that do not necessarily change the
classification
Prototypical Approach
Official Manual for Diagnosing Psychological
Disorders
American Psychiatric Association • DSM : 1952 • DSM-II: 1968 • DSM-III: 1980 • DSM-IIIR: 1987 • DSM-IV: 1994 • DSM-IV-TR: 2000 • DSM-V: 2013
– 5 axes or dimensions used to evaluate an individual – First two are actual diagnosis of disorders; the 3 are criteria required for such diagnosis
Uses a Multi-axial
System
THE AXIS OF DSM IV
Axis I Clinical Attention • Personality Disorders & Mental Axis II Retardation Axis III • General Medical Conditions • Psychosocial and Environmental Axis IV Problems Axis V • Global Assessment of Functioning
REMEMBER
- A REVIEW AND VISIT OF THE DSM IV-TR FORMAT AND ITS DIFFERENT AXIS
- IT’S USE ON HOW TO IDENTIFY PATHOLOGY
– condition established after study
to be chiefly responsible for occasioning the
admission of the individual
*Principal Diagnosis
– when more than one diagnosis is
given for an individual in an outpatient setting, this
is the condition that is chiefly responsible for the
ambulatory care medical services received during the
visit
Reason for visit
REMEMBER
If no Axis I disorder is present, this should
be coded as V71.09
• If an Axis I diagnosis is deferred, pending
the gathering of additional information,
this should be coded as 799.9
DANGERS IN DIAGNOSIS
- The person labeled as abnormal is treated
differently by society and this treatment can
continue long after the person stops
exhibiting the behaviors labeled normal. - Another danger in labeling people is the idea
of stimatization.
AVOIDING DANGERS OF DIAGNOSIS
• DIAGNOSIS is important, however, clinicians
and researchers need to communicate
regarding definitions of disorders.
• When a system of definitions of disorder is
agreed on, then can communication about
disorders be improved.
