Psychological assessments and clinical diagnosis Flashcards
What is the goal of clinical psychological assessments?
To understand the individual, predict behaviour (e.g. are they dangerous to themselves?), plan treatment (evidence based practice) and evaluate treatment outcome
what are Assessment of psychological disorders?https://www.brainscape.com/decks/11113908/cards/quick_new_card
Systematic evaluation and measurement of psychological, biological and social-cultural factors. they try to integrate biological, psychological, interpersonal, social, and cultural into a cohesive model of psychological disorders
value of clinical assessment procedures are determined by
Reliability (consistency)
Validity (accuracy)
Standardization: Procedure to ensure consistency of a technique.
Interrater reliability
- if different people administer the same measure with the same patient they get to the same outcome
Major methods for clinical psychological assessments?
Clinical interviews Observation techniques Tests Biological - measuring psychophysiological responses\ Life records
Clinical interviews types
Open-ended (unstructured)
semi-structured
observation techniques
Open-ended (unstructured) Clinical interview
What does the therapist analyze?
The clinician uses their judgment and intuition to ask questions he looks at Appearance and behaviour Thought process Mood and affect Intellectual Sensorium (awareness) of the patient
Semi-Structured Clinical interview
Here the interviewer follows a list of questions (but they can do it in different ways).
Example: Structured Clinical Interview for Diagnosis (SCID)
Semi-Structured advantage and disadvantage
Advantage: It is comprehensive - it covers every aspect of every disorder - increases inter-rater reliability. The gold standard for diagnosis
Disadvantage: Time consuming
Behavioral Interview
Focus on the here and now
identify problematic behaviour and situations
+ ask about antecedents of behaviour and consequences
What are Observation techniques?
Type of psychological assessment
Where the observer notes the behaviour of patient (different observers can be used - family, clinician, own patient). can be in the lab, clinic, in daily life
Examples of observation techniques
Structured observation schedules
Behaviour approach tests (lab)
Behavioural self-observation
Tests as a psychological assessment procedure
Provide patient with a Consistent stimulus - And the person is scored according to specific criteria. Interpreted relative to normative sample
Tests as a psychological assessment. What can they measure?
Can assess Verbal and nonverbal behavior. Can also assess performance
symptoms, personality, intelligence and neuropsychological, others
Projective tests - assumption
Assumption: person will project aspects of personality onto ambiguous test stimulus
Example: TAT - Thematic apperception test
Projective tests - procedure
Patient projects onto ambiguous stimulus
Clinician interprets this projection, which Requires more clinical inference - mix of validity and reliability data
Objective (Empirical) tests
Test stimuli are less ambiguous
Individuals compared to a large normative group
Examples: Objective personality tests (Such as MMPI), Objective Intelligence tests (WAIS), Neuropsychological tests
Objective (Empirical) tests advatages
extensive reliability, validity and normative info
What does it mean for a test to be compared to a normative group?
Your results are compared to people like you (of your culture, sex, age, etc.) and evaluated based on this comparison - or else confounds may appear
Biological - psychophysiological assessments - domains and use
Electroencephalogram (EEG)
Heart rate and respiration (HR)
Electrodermal response and levels (GSR)
Electromyography (EMG)
Penile/ Vaginal plethysmograph - Sexual arousal
Less commonly used in clinics. More in research
Advantages of Biological psychophysiological assessments
They are more objective, patients can’t control as easily, measures key variables in some disorders
Limitations of Biological psychophysiological assessments
It is affected by many aspects: diet, influences of patient’s emotional setting, situational stress, who the assessor is
It can only be operated by a specialist + expensive equipment
Life Records - psychological assessment
types, advantages and limitation
Types: school records, occupational records, medical history, legal records
Advantages - They are objective. Reflect significant events.
Limitations - Records can have errors
What is the best clinical psychological assessment?
All assessment procedures have strengths and weaknesses
The ideal is to combine information from multiple sources into a coherent picture to get to a conclusion
Clinical Diagnosis
Definition
The act of identifying a disorder from its signs and symptoms
Signs vs Symptoms
signs (what the therapist observes) and symptoms (what the patient reports)
Why conduct diagnosis?
For treatment and prevention planning, summarize information (professional communication), to make research (separate into groups)
Advantages of diagnosis
Patient management and well being (identifying injuries, insurance). Misdiagnosis may be very costly to the individual (e.g. court problems)
Criticisms of diagnosis
Loss of information of the patients psychological frame, diagnosis doesn’t tell you exactly what to do. More analysis is important.
+ Labeling effects - stigma (by patient and people around)
problems with organizing symptoms
Barlow presents 4 models of diagnosis
Categorical
Prototype
Dimensional
Biomedical
Categorical model of diagnosis
Assumptions
Each disorder is unique from every other
All criteria must be met - patients have all the same symptoms
Prototype model of diagnosis
Identifies certain essential characteristics but Allows for symptom variation
DSM-5
Prototypical syndrome
It uses syndromes but patients may not share the same symptoms, while also getting the same diagnosis
DSM-5 Criticism
There are a lot of comorbidity categories
Dichotomous decisions (tem ou nao tem)
only some evidence for decision rules
Reliability at the expense of validity
Cultural and social biases/differences - diagnostic colonialism. + gender bias
Cultural differences Chinese Classification of Mental Disorders (CCMD)
Neurosis, some psychotic disorders that are not in DSM, Neurasthenia, Hysteria are still there
Traveling psychosis, Psychogenic disorders
Koro: Belief that genitals retract
Psychogenic sub-category of culture-related disorders
Qigong-induced: short-lived fright, delusions, identity disturbance, suicidal, bizzare and violent behaviour
+ Mental disorders related to superstition and witchcraft
Dimensional models of diagnosis
Rates individual on the severity of symptoms in a variety of symptoms
Yields a profile of symptoms or of syndromes - of the patient which actually reflects the way symptoms appear in humans
+ Psychopathology hierarchy of dimensional models
Critique of hierarchical dimensional model
It is essentially categorical - like the other models
Problems with construction - what should you use to to develop the categories of dimensions?
Biomedical model
National institute of Mental Health
Psychological disorders conceptualized as “brain dysfunctions”
classification based on clinical observation
Identifying genetic influences, neurochemistry and brain circuits is necessary to determine the true nature of psychopathology - The objective model
biomedical model - Research Domain Criteria (R-DoC)
“grid” of variables - the total grid can potentially create 312 factorial combinations = Research domain matrix
Biomedical model criticism (Hayes)
Biomedical studies do not know a single biological marker for any disorder
Lack of specificity in neural and genetic correlates
Correlation is not causation
Confounds with effects of medication, Socioeconomic status and etc
Stigma in Biomedical explanation
Increases patients pessimism and perceived danger
Reduces blame by others but heightens self blame
Ignores epigenetics, learning, culture and SES.
Too complex + not enough research for treatment
