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Clinical Assessment and Diagnosis

Clinical Assessment and Diagnosis. Chapter 3 Abnormal Psychology. Clinical Assessment. Protocols used for evaluation and measurement Assessing/diagnosing psychological disorders. Getting Started. What brings the client to the provider?

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Clinical Assessment and Diagnosis

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  1. Clinical Assessment and Diagnosis Chapter 3 Abnormal Psychology

  2. Clinical Assessment • Protocols used for evaluation and measurement • Assessing/diagnosing psychological disorders

  3. Getting Started • What brings the client to the provider? • Discussion of the presenting problem and the client’s history

  4. Concepts in Assessment • Reliability: the consistency of measurement • Validity: does it measure what it is meant to measure? • Standardization: comparing individuals with similar persons; asking questions in a consistent manner

  5. Current and past behavior Emotions and attitudes A detailed history The presenting problem Significant life events Childhood information and family history Sexual development Religious beliefs/cultural background Educational history The Clinical Interview

  6. The Mental Status Exam • 1. Appearance and Behavior-motor behavior, movements • 2. Thought process-rate/flow of speech; coherence; any evidence of delusions/hallucinations? • 3. Mood and Affect-what is the mood and is it consistent? What is affect like and is it appropriate?

  7. The Mental Status Exam • Intellectual functioning:vocabulary, use of language; general sense of cognitive abilities • Sensorium:Awareness of immediate surroundings; Oriented x3? (Person, place, time)

  8. Issues to Consider • Is the client presenting the central issues? Are there other issues the client sees as unimportant? • Establishing rapport • Confidentiality: Scope and limitations

  9. Other Clinical Interviews • Interviews or instruments specific to a particular disorder or concern: to learn the specific symptoms and their severity • Anxiety Disorders Interview Schedule- questions specific to compulsions and obsessions • Eating Disorder interviews/scales

  10. Physical Exam • Physical problems may mimic psychological disorders • Thyroid issues • Brain lesions/tumors • Dementia • Drug induced conditions

  11. Behavioral Assessments • Observing the client in specific contexts, in real life settings or simulated situations • Asking others to fill out behavior “checklists” • Often used with children: school and home visits

  12. Self-Monitoring • Clients may be asked to keep a log of their thoughts/behaviors • When the behaviors occur in private • To note frequency, severity, and “triggers”; for self-reflection

  13. Overview of Psychological Tests • Projective Tests • Personality Inventories • Intelligence Tests • Neuropsychological Tests

  14. Projective Tests • Client “projects” thoughts and feelings- to reveal unconscious thoughts • Rorschach (ink blot test) • Thematic Apperception Test (TAT) • Critique: limited reliability/validity; not directly linked to the process of diagnosis

  15. Personality Inventories • Comparing an individual’s score with the pattern of responses of those with diagnosed psychological conditions • MMPI: Minnesota Multiphasic Personality Inventory • 567 true/false questions

  16. MMPI • Sample Questions: • I often think I’m being followed • I am often happy for no reason • Sometimes I get so mad I want to swear • I sometimes throw up after meals • Evil spirits possess me at times

  17. Clinical Scales: 1: Hypochondriasis 2: Depression 3: Hysteria (Conversion) 4: Psychopathic Deviant 5: Masculinity/Femininity 6: Paranoia 7: Psychastenia (Anxiety) 8: Schizophrenia 9: Hypomania 0: Social Introversion Lie Scale; Infrequency Scale (to detect random answers); Defensiveness Scale MMPI: Scales

  18. MMPI • Results in a “code type” • Looking at answers left blank • Excellent reliability, good validity

  19. Neuropsychological Tests • Neuroimaging • CAT scans/MRI: to assess brain damage and to look at the structures of the brain • PET scans: the functioning/activity of the brain • EEG: brain waves

  20. Issues in Diagnosis • Diagnostic and Statistical Manual • Reliability/Validity • Some diagnoses have greater reliability/validity than others • Personality Disorders tend to have lower reliability

  21. Diagnostic and Statistical Manual • I and II were not widely used; lacked precision, were unscientific, and had little reliability • DSM III: 1980: more atheoretical; more precise descriptions; reliability/validity studies

  22. Axes 1-5 • Five “Axes” or Dimensions • Axis I: The Disorder • Axis 2: Personality Disorder/MR • Axis 3: Medical Conditions • Axis 4: Problems: Psychosocial & Environmental • Axis 5: Global Assessment of Functioning (Scale)

  23. Critique of the DSM • Culturally sensitive? • Stigma of labels • “Fuzzy” categories and co-morbidity • Categories based more on history than current science? (Kraeplin’s dichotomy)

  24. DSM-V • In progress • Various workgroups: clinicians and researchers • Revisions/new additions

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