Clinical Assessment and Diagnosis Flashcards
Specific phobias are excessive…
irrational fears of a given object or situation
The prevalence of phobias is…
high, affecting ~9% of Americans and twice as many women as men
The five possible subtypes of phobias are…
animal, environmental, blood-injection-injury, situational, and “other”
Onset of phobias is often in…
childhood, with animals phobias usually earliest (~age 7), then blood (~age 9)
Assessment
a process that may or may not result in a DSM diagnosis
Purposes of assessment:
Gather information about a person’s concerns and functioning, especially the problems that brought them in, Form diagnostic impressions, Provide treatment recommendations or plan treatment, Evaluate treatment outcome
What do psychologists do to assess a person?
Examine medical or previous treatment records, Clinical interviews, Behavioral assessment and observation
Psychological tests
Clinical interviews
Including the Mental Status Exam
Psychological tests
Projective tests, Self-report inventories, Psychoeducational, Neuropsychological
Clinical Interviews can be…
Structured (e.g., SCID, DISC, MINI), Semi-structured, or even un-structured (Often includes a mental status exam)
The goal of clinical interviews is to understand:
The presenting problem or chief complaint, the person’s history and functioning in a variety of domains, any symptoms that are present
Why are unstructured clinical interviews occasionally unsuccessful?
Because information is commonly missed
What is the purpose of the Behavioral Assessment and Observation?
To focus on and understand a current problematic (or “target”) behavior and to help the client to identify the ABC’s
What are the ABC’s and when do they occur?
Antecedents, Behavior, and Consequences (A and C occur immediately before and after the B)
In the behavioral assessment and observation the clinician will have to decide…
Will the person self-monitor or be observed by another person? (Problem of reactivity using direct observation by another person)
Projective Tests
Have roots in the psychoanalytic tradition, Involve presenting an ambiguous stimulus and asking for a response, Idea is that the person will “project” attitudes, motivations, and personality onto the stimulus, Require a high degree of inference/opinion in scoring and interpretation = generally unscientific
Examples of Projective Tests
The Rorschach Inkblot Test
Thematic Apperception Test
Strengths of Projective Tests
Can be more engaging and helpful with resistant clients, harder to “fake” responses
Weaknesses of Projective Tests
Based on little scientific evidence, poor reliability and validity
The Rorschach Inkblot Test
xxx
Thematic Apperception Test
xxx
Self-Report Inventories are often called “objective” tests, because…
they are rooted in the empirical (research-based) tradition
Description of Self-Report Inventories test
Tests are less ambiguous and purpose is more obvious, Require minimal inference/opinion in scoring = more valid/scientific, interpretation can still be challenging depending on the test (Example of a very useful but very complicated test = MMPI-2 (or MMPI-A)
Psychoeducational Testing
Often done by school psychologist, but most clinical/counseling psychologist are also trained in administration/interpretation; Includes IQ (aptitude) testing and Achievement Testing
IQ (aptitude) Testing
IQ is a score assumed to reflect an individuals intellectual abilities as compared to same-aged individuals (vernal vs. performance domains)
Achievement Testing
Used to assess a persons level of academic achievement; Necessary when conducting a learning disability assessment
Neuropsychological Testing
Conducted most often by neuropsychologist, but some Clinical psychologist are trained as well; purpose is to understand brain behavior relationship, may also involve Nero imaging techniques, test are more focused on cognitive functioning (ex. attention, memory, visuospatial tasks, processing speeds)
Examples of Neuropsychological Tests
The Luria-Nebraska and Halstead-Reitan Batteries
Two Distinct approaches for classifying psychological disorders
Categorical vs. Dimensional
Categorical
Very black-and-white; the person either has a disorder or does not
Dimensional
Evaluate the extent to which a person is exhibiting a problem
The DSM has traditionally been…
Categorical, and still is to a large extent. However there is an obvious shift toward dimensional classification in DSM-5 and this will continue moving forward
Often cited problems with DSM
Extensive comorbidity of disorders, Labeling and stigmatization, Using dimensions (lower diagnostic threshold), Are there too many new diagnoses as the DSM evolved?, Does it do well taking culture into account?(DSM is a controversial manual with many supporters and many critics)
