Week 7 Clinical Testing Flashcards
What are the objectives of clinical testing? (DDD)
diagnose (if symptoms meet criteria for a disorder),
develop a case formulation,
design and implement a treatment plan.
How does a professional collect information during a clinical assessment?
- observation (behavioural assessment)
- clinical interview
- clinical tests
- measures of pre-morbid functioning
What are the 6 steps of clinical testing
- referral for assessment
- referral questions provided
- assessor prepares by selecting appropriate assessment tools e.g. interview, records, tests, questionnaires
- assessment is conducted
- feedback for client/ family
- Assessor writes psychological report which aims to answer the referral question
According to the DSM-5, a mental disorder is:
A mental disorder is a syndrome characterized by ___ ____ disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in s____, o___, or other important activities.
An expectable or ___ approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.
An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder
How is a diagnosis useful?
- facilitates communication between various health professionals thus guiding treatment plans
- understanding - client knows what their symptoms mean
- groups of people with the same symptoms can be studied together
- evidence-based guidelines
How might a diagnosis be harmful?
- leads to stigma and bullying/ mistreatment
- removes the “human” aspect of treatment as a diagnosis is quite rigid
- does not reflect comorbidities
- may not reflect cultural differences
- biomedical model may not align with therapy style
define diagnosis and state how a psychological diagnosis may be limited in comparison to a biomedical one.
A diagnosis determines the nature of a disorder by identifying signs and symptoms against a set of criteria.
Limited as it relies on psychological phenomenon and observation of behaviour which does not really reflect aetiology. Compared to a medical diagnosis which has strong causal mechanisms and be tested by sound tests e.g. blood tests/ scans.
complete the following quote:
“A hypothesis about the ____ , precipitants, and
_____ influences of a person’s psychological, interpersonal,
and behavioural problems; it guides therapy by helping to identify
____ ____, and potential problems that may arise” (Levenson & Strupp, 2007)
“A hypothesis about the predisposing, precipitants, and
maintaining influences of a person’s psychological, interpersonal,
and behavioural problems; it guides therapy by helping to identify
treatment goals, and potential problems that may arise” (Levenson & Strupp, 2007)
In terms of case formulation, what are the 4 P’s?
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
What is another name for predisposing factors?
sources of vulnerability
Describe predisposing factors
factors which make a client more vulnerable to their presenting problem e.g. history of trauma, genetics
Describe precipitating factors
immediate factors/events which have caused the client to present at this time e.g. trigger to presenting problems
Describe perpetuating factors
contribute to continuation/worsening of symptoms - maintenance of presenting problem e.g. withdrawing when lonely may cause ppl to avoid us more.
Describe protective factors
capacity for resilience, client strengths and supports e.g. social support, talents, skills
During a clinical interview, what are the main goals of an assessment?
- determine if client is a risk to themselves or others
- diagnosis
- gauge client insight - do they know what’s happening/why
- decision regarding further assessment or involving other teams
During a clinical interview, what are the main goals of an treatment/ intervention?
- develop therapeutic relationship
- pinpoint goals for psychotherapy
- outline main responsibilities and boundaries of each party
What are 3 factors which can differentiate clinical interviews
tone (directive/ non-directive)
structure (standardised or not)
content (broad or specific)
List the elements of a clinical interview which are present in the case study:
Dr. Leshae conducted a clinical interview for her new client, 23 year old Maddison Smith in her office at a secure private practice clinic. Before she began the interview process, she asked her client how she would like to be addressed, Maddison said her preferred name is “Maddie”. Then, Dr. Lee said, “I want you to feel free to talk openly, what you say stays between us, however, there are circumstances where I may need to disclose to others…”.
After that, Dr. Lee said “so tell me about yourself”. She then followed up with another type of question, e.g. “how long does that symptom last?”.
Throughout the interview process, Dr. Lee remained engaged, warm and non-judgmental. She also limited the amount she spoke about her personal life and she did not view silence during the session as awkward.
- private & safe environment
- confidentiality and its limits
- open ended questions
- close ended questions
- interested, warm and non-judgemental
- limit self-disclosure
- learn to use silence
What is a mental state exam (MSE)?
What does the pneumonic ASEPTIC stand for?
“Physical” examination of the mind and includes both objective (what is observed of client) and subjective data (what client described)
Appearance/behaviour
Speech
Emotion/Affect
Perception
Thought content and thought processing
Intellectual resources, Insight and Judgement
Cognition
Consider the following example description from the lecture:
Lucy is a 34 year-old Portuguese woman of average weight and height. At the time of examination, she was well groomed and dressed. On appearance, there were no signs of tremor or abnormal movements. Lucy was cooperative throughout the interview. She maintained eye contact, except during the times when recounting the history of her father’s death and her previous marriage.
a) identify which aspect of ASEPTIC is being described
a) Appearance/ behaviour - Well groomed? Dress appropriate? Eye contact? Unusual mannerisms or psychomotor activity? Any coordination difficulties?
Consider the following example description from the lecture:
Lucy’s thought content was largely focused around her health. She was preoccupied with knowing her biopsy result and this was reflected in her behaviour of constantly asking the doctors and nurses for the results. Concerns that the tumour could be cancerous were causing Lucy to lack motivation and feel restless. Lucy displayed no symptoms of delusions, phobias or compulsions. Lucy denied suicidal ideation and self harming behaviours. No formal thought disorder was identified in Lucy’s presentation. Lucy responded to questions appropriately.
a) identify which aspect of ASEPTIC is being described
Thought content and thought processing.
Thought content - delusions, phobias, obsessions, magical thinking. Any thoughts of harm to self or others?
Thought processing - tangential thinking, are thoughts coherent?, is there a flight of ideas?
Lucy presented with depressed mood and restricted affect. She also appeared anxious and irritable at times during the assessment.
a) identify which aspect of ASEPTIC is being described
Emotion (Mood & Affect) - Is there consistency between client’s described mood and the observed affect? Is the client’s emotional expression appropriate?”
Mood - what the client reports. it is like the “climate”. Predominate emotion over days/weeks
Affect - current emotional state that the clinician observes. it is like the “weather”.
Lucy exhibited normal perception and denied experiencing hallucinations.
a) identify which aspect of ASEPTIC is being described
Perception - Any hallucinations, illusions or distortions (auditory, visual, olfactory, tactile)
Lucy articulated herself clearly. She answered questions spontaneously, although at slow rate. She spoke softly throughout the conversation, particularly when mentioning past unhappiness.
a) identify which aspect of ASEPTIC is being described
Speech - Rate, fluency, quality & quantity of speech?
Lucy’s intellectual ability is probably at least in the above-average range. She completed serial sevens and other concentration tasks with little difficulty.
When questioned about her condition, Lucy accepted the fact that she is ill and requires treatment. She has cooperated with doctors and nurses and is compliant with management. She displayed good insight and her judgement appears
a) identify which aspect of ASEPTIC is being described
Intellectual resources - Is there evidence that the client is resourceful and functions adequately in a number of life domains? Are mistakes due to limited ‘intellectual ability’ rather than clinical psychopathology?
Insight - intact, partial or poor) Does the client understand their situation and the necessity for professional assistance?
Judgement - How appropriate has the client’s decision-making been with regard to past events and future plans?
Lucy was alert and orientated to time, place and person. She displayed good attention. Her remote, recent, and immediate memory appeared intact.
a) identify which aspect of ASEPTIC is being described
Cognition -
➢ Level of Consciousness – Is the client alert, drowsy, delirious or confused?
➢ Orientation – Oriented to time, place and person?
➢ Attention – Any problems with attending and concentrating?
➢ Memory – Any difficulties in recalling immediate, recent or remote information?
What does it mean to be culturally informed when conducting a clinical assessment?
Defined as an approach to evaluation that is perceptive of and responsive to issues of acculturation, values, identity, worldview, language, and other cultural-related variables as they may impact the evaluation process or the interpretation of resulting data.
- Customs regarding personal space, eye contact, touch
- Reporting of physical symptoms
- Meaning of distress/disorder in other cultures
- Use of translators/interpreters
In order to be considerate of individual differences, clinicians must consider certain factors. What does the pneumonic “ADDRESSING” mean?
Age & generation
Developmental disability
Disability (acquired)
Religion
Ethnicity & race
Social status (income, education and occupation)
Sexual orientation
Indigenous status
National origin & language
Gender
There are special application for clinical testing when assessing individuals presenting with Alcohol and Other Drugs concerns.
Describe theses applications and give examples of tools used in AOD assessment.
- toxicology tests (tox screen)
- testing for addiction severity, personality traits associated with abuse and client insight/judgement.
examples
- AUDIT - Alcohol use disorders identification test
- ASSIST - Alcohol, smoking, and substance involvement screening test
- APS - Addiction potential scale
- ASI - addiction severity index
What are the special applications for forensic assessments? Referral questions? examples of tools?
Forensic clinical assessments are applied psychological evaluations and measurements in a legal context which assist a legal decision maker.
Referral questions may include:
- child custody
- competency to stand trial
- personal (emotional injury)
- risk assessment/ managment
- disability/workers compensation
- parenting capacity
- criminal responsibility
Examples:
- Stalking risk profile (SRP)
- HCR-20 Violence Risk Assessment
- The Risk for Sexual Violence Protocol (RSVP)
What are some physical, emotional and behavioural signs of abuse/neglect during childhood?
examples of trauma assessment
- physical injuries
- dressing inappropriately for the weather to cover signs of injury
- unusual fear of physical contact
- AOD use
- Regressive/ unusual behaviours e.g. nervousness, withdrawal, aggression, bedwetting
➢ Childhood Trauma Questionnaire (CTQ)
➢ Brief Trauma Questionnaire (BTQ)
Describe the structure of a psychological report.
- Identifying Information: patient’s name, date of birth, date(s) of assessment
- Reason for Referral: reason for referral and who initiated the referral
- Background Information: patient’s current problems, relevant historical information (e.g., developmental history, health history, prior test results)
- Assessment methods & tests administered (if any): description of methods, names of tests administered and date ( e.g., “BDI-II, 12/4/2021”; “CTQ, 12/4/2021)
- Results/Findings: findings and observations during assessment; any variables that may have affected test results
- Recommendations: recommendations to assist with presenting problems (e.g., psychotherapy, placement in special class)
- Summary: concise statement summarising who examinee is, why they were referred for testing, what was found, and what needs to be done
What is the Barnum Effect?
The Barnum Effect: people tend to accept vague and general personality descriptions as uniquely applicable to themselves without realising the same description could be applied to just about anyone
