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Chapter 3 Clinical Assessment, Diagnosis, and Research Methods

Chapter 3 Clinical Assessment, Diagnosis, and Research Methods. Assessing Psychological Disorders. Purposes of Clinical Assessment To understand the individual To predict behavior To plan treatment To evaluate treatment outcome. Assessing Psychological Disorders (continued).

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Chapter 3 Clinical Assessment, Diagnosis, and Research Methods

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  1. Chapter 3Clinical Assessment, Diagnosis, and Research Methods

  2. Assessing Psychological Disorders • Purposes of Clinical Assessment • To understand the individual • To predict behavior • To plan treatment • To evaluate treatment outcome

  3. Assessing Psychological Disorders (continued) • Analogous to a Funnel • Starts broad • Multidimensional in approach • Narrow to specific problem areas

  4. Key Concepts in Assessment • Reliability • Consistency in measurement • Examples include test-retest and inter-rater reliability • Validity • What an assessment approach measures and how well it does so • Examples include concurrent, discriminant, and predictive validity

  5. Key Concepts in Assessment (continued) • Standardization and Norms • Ensures consistency in the use of a technique • Provides population benchmarks for comparison • Examples include structured administration, scoring, and evaluation procedures

  6. Domains of Assessment: The Clinical Interview and Physical Exam • Clinical Interview • Most common clinical assessment method • Structured or semi-structured

  7. Domains of Assessment: The Clinical Interview and Physical Exam (continued) • Mental Status Exam • Appearance and behavior • Thought processes • Mood and affect • Intellectual functioning • Sensorium • Physical Exam

  8. Domains of Assessment: Behavioral Assessment and Observation • Behavioral Assessment • Focus on the present – Here and now • Direct observation of behavior-environment relations • Purpose is to identify problematic behaviors and situations • Identify antecedents, behaviors, and consequences

  9. Domains of Assessment: Behavioral Assessment and Observation (continued) • Behavioral Observation and Behavioral Assessment • Can be either formal or informal • Self-monitoring vs. being observed by others • Problem of reactivity using direct observation

  10. Domains of Assessment: Psychological Testing and Projective Tests • Psychological Testing • Must be reliable and valid • Projective Tests – Roots in Psychoanalytic Tradition • Project aspects of personality onto ambiguous test stimuli • Require high degree of inference in scoring and interpretation

  11. Domains of Assessment: Psychological Testing and Projective Tests (continued) • Examples • The Rorschach Inkblot Test, Thematic Apperception Test • Reliability and validity data tend to be mixed

  12. Domains of Assessment: Psychological Testing and Objective Tests • Objective Tests – Roots in Empirical Tradition • Test stimuli are less ambiguous • Require minimal clinical inference in scoring and interpretation • Objective Personality Tests • Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-A) • Extensive reliability, validity, and normative database

  13. Domains of Assessment: Psychological Testing and Objective Tests (continued) • Objective Intelligence Tests • Nature of intellectual functioning and IQ • The deviation IQ • Verbal and performance domains

  14. Domains of Assessment: Neuropsychological Testing • Purpose and Goals • Assess broad range of skills and abilities • Goal is to understand brain-behavior relations • Examples • The Luria-Nebraska and Halstead-Reitan Batteries

  15. Domains of Assessment: Neuropsychological Testing (continued) • Problems with Neuropsychological Tests • False Positives • False Negatives

  16. Domains of Assessment: Neuroimaging and Brain Structure • Neuroimaging: Pictures of the Brain • Allows for a window on brain structure and function • Imaging Brain Structure • Computerized axial tomography (CAT or CT scan) • Utilizes X-rays

  17. Domains of Assessment: Neuroimaging and Brain Structure (continued) • Magnetic resonance imaging (MRI) • Utilizes strong magnetic fields • Better resolution than CT scan

  18. Domains of Assessment: Neuroimaging and Brain Function • Imaging Brain Function • Positron emission tomography (PET) • Single photon emission computed tomography (SPECT) • Both involve injection of radioactive isotopes • Isotopes react with oxygen, blood, and glucose in the brain • Functional MRI (fMRI) – Brief changes in brain activity

  19. Domains of Assessment: Psychophysiological Assessment • Psychophysiological Assessment • Assess brain structure, function, and activity of the nervous system • Psychophysiological Assessment Domains • Electroencephalogram (EEG) – Brain wave activity • Heart rate and respiration – Cardiorespiratory activity • Electrodermal response and levels – Sweat gland activity

  20. Domains of Assessment: Psychophysiological Assessment (continued) • Uses of Routine Psychophysiological Assessment. • Disorders involving a strong emotional component • Examples • PTSD, sexual dysfunctions, sleep disorders • Headache and hypertension

  21. Diagnosing Psychological Disorders: Foundations in Classification • Diagnostic Classification • Classification is central to all sciences • Assignment to categories based on shared attributes or relations

  22. Diagnosing Psychological Disorders: Foundations in Classification (continued) • Terminology of Classification Systems • Taxonomy – Classification in a scientific context • Nosology – Taxonomy in psychological/medical phenomena • Nomenclature – Nosological Labels (e.g., panic disorder)

  23. Issues with Classifying and Diagnosing Psychological Disorders • Categorical vs. Dimensional Approaches • Classical (or pure) categorical approach – Strict categories • Dimensional approach – Classification along dimensions • Prototypical approach – Combines classical and dimensional views

  24. Issues with Classifying and Diagnosing Psychological Disorders (continued) • Two Widely Used Classification Systems • ICD-10 • International Classification of Diseases and Health Related Problems (ICD-10) • Published by the World Health Organization • DSM-IV & DSM-IV-TR • Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-IV-TR)

  25. The DSM-IV-TR • Basic Characteristics • Five axes – Full clinical presentation • Clear inclusion and exclusion criteria for disorders • Disorders are categorized under broad headings • Empirically-grounded, prototypic approach to classification

  26. The DSM-IV-TR (continued) • The Five DSM-IV Axes • Axis I: Most major disorders • Axis II: Stable, enduring problems (personality disorders, mental retardation) • Axis III: Related medical conditions • Axis IV: Psychosocial problems • Axis V: Global rating of adaptive function

  27. Unresolved Issues in the DSM-IV-TR • The Problem of Comorbidity • Defined as two or more disorders for the same person • High comorbidity is the rule clinically • Threatens the validity of separate diagnoses • Labeling Issues and Stigmatization

  28. Summary of Clinical Assessment and Diagnosis • Clinical Assessment and Diagnosis • Aims to fully understand the client • Aids in understanding and ameliorating human suffering • Based on reliable, valid, and standardized information

  29. Summary of Clinical Assessment and Diagnosis (continued) • Dangers of Diagnosis • Reification & stigmatization • Clinical Assessment and Diagnosis • The core of abnormal psychology • A multidimensional perspective

  30. Conducting Research in Psychopathology • Questions Driving a Science of Psychopathology • What problems cause distress or impair functioning? • Why do people behave in unusual ways? • How can we help people behave in more adaptive ways?

  31. Basic Components of Research • Starts with a Hypothesis or “Educated Guess” • Not all hypotheses are testable • Hypotheses in science are formulated so that they are testable

  32. Basic Components of Research (continued) • Research Design • A method to test hypotheses • Independent variable • The variable that causes or influences behavior • Dependent variable • The behavior influenced by the independent variable

  33. Considerations in Research Design • Internal Validity vs. External Validity • What is internal validity? • What is external validity? • Ways to Increase Internal Validity by Minimizing Confounds • Use of control groups • Use of random assignment procedures • Use of analog models • Relation Between Internal and External Validity

  34. Statistical vs. Clinical Significance • Statistical Methods – Branch of Mathematics • Helps to protect against biases in evaluating data • Statistical vs. Clinical Significance • Statistical significance – Are results due to chance? • Clinical significance – Are results clinically meaningful? • Statistical significance does not imply clinical meaningfulness

  35. Statistical vs. Clinical Significance (continued) • Balancing Statistical vs. Clinical Significance • Evaluate effect size • Evaluate social validity • Generalizability and the Patient Uniformity Myth

  36. Studying Individual Cases • Case Study Method • Extensive observation and detailed description of a client • Foundation of early historic developments in psychopathology • Limitations • Lacks scientific rigor and suitable controls • Internal validity is typically weak • Often entails numerous confounds

  37. Research by Correlation • The Nature of Correlation • Statistical relation between two or more variables • No independent variable is manipulated • Range from –1.0 to 0 to +1.0 • Negative vs. positive correlation

  38. Research by Correlation (continued) • Limitations • Does not imply causation • Problem of directionality • Epidemiological Research -- An Example of the Correlational Method • Incidence, prevalence, and course of disorders • Examples - AIDS, trauma following disaster

  39. These three graphs represent hypothetical correlations between age and sleep problems Fig. 3.6, p. 103

  40. Research by Experiment • Nature of Experimental Research • Manipulation of independent variables • Attempt to establish causal relations • Group Experimental Designs • Control groups • Placebo vs. double-blind controls

  41. Research by Experiment (continued) • Comparative Treatment Designs • Type of group design • Compare different forms of treatment in similar persons • Addresses treatment process and outcome

  42. Single-Case Experimental Designs • Nature of Single Subject Design • Rigorous study of single cases • Varied experimental conditions and time • Repeated measurement • Evaluation of variability, level, and trend • Premium on internal validity • Types of Single-Subject Design • Withdrawal designs • Multiple baseline designs

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