Week 2 Part II Chapter 3 - Clinical Assessment and Diagnosis (Post) Flashcards
Describe a Clinical assessment.
The systematic evaluation and measurement of psychological biological and social factors in an individual who’s presenting with a possible psychological disorder
What makes clinical assessments hard and how is this challenge overcome?
Challenge: no visible biomarkers
Physical assessment
Make sure there’s no physical issue causing the disorder
Mental status exam:
1. What is it?
2. What are the 5 categories?
Systematic observation of behaviour in an attempt to determine if disorder is present
- Appearance and behaviour: clinicians note physical behaviour (leg twitch) dress physical appearance posture facial expressions
Ex. Slow effortful behaviour can be known as psychomotor retardation - sign of severe depression - Thought process: Does person talk fast or slow? Do they make sense when they talk? Do ideas have connection? Rate and continuity of speech? Any evidence of delusions?
Ex. delusion of persecution
Ex Idea reference: everything everyone else does relates back to them
3/4. Mood and affect: Mood= feeling state. Is the person happy or sad? Do they talk depressed or hopeful? Times when depression isn’t there? Affect= state accompanied by specific time?
Ex. Laughing when mum dies
Intellectual functioning: Clinician make rough estimate of others intellectual functioning through conversation.Do they have a reasonable vocabulary? Do they use metaphors? Do they go to school? How is their memory? Notice when it deviates from norm.
- Sensorium: general awareness of our surroundings. Does an individual know date, time, where they are, who they are who you are? Want at least person place and time.
Rawarshaw or inkblot tests are an example of….. Testing
projective
Diagnosis is…..
the process of determining if the problem affecting the individual meets the dsm5tr criteria for a psychological disorder.
Explain the process of a clinical interview
- Semi structured
Presenting problem:- What brings you here
Brief life history:
- Pay attention to all the things that make them them
Medical history (hospitalization, Brain injuries etc.
Current symptoms (when did symptoms start what have they been like)
- Onset: when did it start
- Course: how has it gone
- Is it gradual sudden do you always feel it
All of this rests on rapport
- Do they trust you
- Are they honest?
- Build conection
If they don’t feel comfortable then talk about it
What is the section on the mental status exam that evaluates an individuals general awareness
Sensorium
What are the two main personality inventories? Pros and cons
MMPI
Little room for interpretation of MMPI responses
Issue: time it takes to respond to 567 items
Individual responses not monitored
We care about the patterns
To control for faking answers to look good the mmpi determines validity with questions like “ I have never had a bad night’s sleep
PAI
Both work to compare a patient to norms
What are two popular iq tests? What are the 4 sections it tests for ?
Wechsler Adult intelligence scale
(WAIS-IV)
Wechsler intelligence scale for children
(WAIS-V)
Adult version evaluates 4 abilities:
Verbal comprehension
Perceptual organization
Processing speed
Working memory
What do neuropsychological tests test for? How does it work? What 4 areas are tested? Pros? Cons?
Asses brain dysfunction by observing its effects on a person’s ability to function. They are objective standardized tests of:
1. Attention
2. Memory
3. Language
4. Visuospatial skills executive functioning
Validity of neuropsychological testing: useful to detect disorders and dysfunction or development of disorders
Issue:Test sometimes shows false positives (problem when there isn’t really one or false negative (no problem when there actually is
Neuroimaging
What is it?
Give me some examples explain their differences and how they work?
CT, MRI, PET SPECT, fMRI
Neuroimaging is pictures of the brain used to figure out functioning or problems
CT or CAT scans: useful for identifying and locating abnormalities in the structure or shape of the brain.
Useful for tumours injuries or abnormal shape
MRI: helpful to identify regions or damage signal is lighter
- Takes longer than ct more expensive
- Can cause Claustrophobia
PET: Used to look at varying patterns of glucose metabolism, which can be associated with diff disorders
SPECT: uses gamma rays to create 3D images of the inside of the body
fMRI: Can capture pictures of brain at work
See how it changes
Formulation
Explanation of how disorder develops
Classification
Assign people to categories based in shared traits
allows there to be treatment that’s generalizable to all people with adhd…
DSM3
- multi axl system and 4
1980
Two main changes
take an atheoretical approach to diagnosis, relying on precise descriptions of the disorders as they presented to clinicians rather than on psychoanalytic or biological theories of etiology
Specific criteria listed made it possible to test reliability and validity
Large impact
DSM5
- No axis
- Instead prototypical approach (categories)
DSM5 text revision
- Dsm is written by and for psychiatrists
- Apa American psychiatric association
- Psychiatrists developing a system for psychiatrists
- Threshold is lowering
Prototypical approach
Identifies essential characteristics of an entity so it can be classified, still permits personal variation that don’t impact classification
DSM 5 uses a prototypical approach (essential things need for a person to meet criteria for a psychological disorder but some things can vary
Schizophrenia
Structure of diagnosis
Two or + of the flowing for 1 month (one must be one of the first 3)
1. Delusions (thoughts or beliefs that can’t be true)
2. Hallucinations sensory experiences that aren’t there
3. Disorganized speech-saying things that don’t make sense
4. grossly disorganized behaviour
5. Negative symptoms
- Signs of disturbance MUST LAST AT LEAST 6 MONTH
Criticisms of DSM/ICD
Fuzzy categories cause an increasing amount of comorbidity (there is overlap).
Emphasizes reliability (consistency) at the expense of validity
Vulnerable to misuse-labels become stigmatized
The diagnostic threshold is being lowered! It’s easier for people to get a diagnosis and we might be over-pathologizing normal people with disorders.
Who is Allen Frances? What’s his deal?
On board of dsm-4
Criticisms of lowering the threshold
Prolonged grief disorder is said to be a disorder if it lasts more than 6 months for a kid or a year for an adult.
How can we put a time on something like this? We can’t pathologize what’s normal?
Katherine Shear and her views on prolonged grief disorder
She is pro
If getting a diagnosis helps people get the treatment they need for dealing with their grief then why shouldn’t we be supportive of this?
What would be the perfect diagnostic system? What’s the best we can do?
Perfect system:
- Describes all presenting symptoms
- Etiology (cause) written into dx
Accurate prognosis and response to treatment
No overlap
Perfect cure
Best we can do:
- We don’t fully understand the cause of behavioural disorders often there’s no physical issue.
- So what we do is try and categorize human behaviour then hypothesis and make further assessments
Dimensions and spectrum approaches
Move away from strict classifications and into spectrum on a continuum
As part of a mental status exam a clinician might ask a patient about whether they know what their name is and what the date is this domain is known as…
sensorium
A clinician exam assessment can’t began without…
Informed consent
The Rochester and ink blot is an example of …. test because it assumes clients project facets of their personality onto ambiguous stimuli
Projective
Clinical interviews are….because although there is a specific set of questions to use, clinicians depart from the list to explore specific issues.
Semi structured
Following a car accident, a client presents with possible brain impairment. What kind of tests should be included in their assessment
Neuropsychological tests
What type of approach does the dm=5 use.
Hint it specifies essential features of a disorder while allowing variability.
Prototypical approach
Criticism of dsm5-tr is that there are too many blurred boundaries between diagnostic categories
Comorbidity
One of the largest personality tests
Contains L scale that lets you know if someone is lying
MMPI
What are the 5 parts of the mental status exam?
Sensorium: who/where you are
Appearance and behaviour
Though process
Mood/affect
Intellectual functioning
