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Module 3: Clinical Assessment, Diagnosis, & Treatment

Understand key concepts in clinical assessment, including reliability, validity, and standardization. Learn about clinical interviews, physical examinations, psychological tests, and neurological assessments. Distinguish general purposes of assessment and diagnosis, explore DSM history, and criticisms of DSM-5.

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Module 3: Clinical Assessment, Diagnosis, & Treatment

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  1. Module 3:Clinical Assessment, Diagnosis, & Treatment

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

  3. Key Concepts in Assessment • Reliability • Consistency is measurement • Examples include test-retest & inter-rater reliability • Validity • What an assessment approach measures & how well it does so • Examples include concurrent/descriptive and predictive validity • Standardization and Norms • Ensures consistency in the use of a technique • Provides population benchmarks for comparison • Examples include structured administration, scoring, and evaluation procedures

  4. The Clinical Interview • Clinical Interview • Most common clinical assessment method • Mental Status Exam • Appearance and behavior • Thought processes • Mood and affect • Intellectual functioning • Sensorium (awareness of environment)

  5. Clinical Interview (continued) • Confidentiality – between patients & mental health professionals; protected by law in most instances (i.e. except in Tarasoff’s law) • Types of interviews: unstructured & semistructured clinical interviews

  6. Physical Examination • Rules out medical explanations for psychological disorders • Examples: toxic state, hyperthyroidism, hypothyroidism, brain tumors, drug ingestion

  7. 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 • Can be either formal or informal • Self-monitoring vs. being observed by others • Problem of reactivity using direct observation

  8. Psychological 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 • Examples • The Rorschach Inkblot Test, Thematic Apperception Test • Reliability and validity data tend to be mixed

  9. Psychological Tests (continued) • Personality Tests • Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-A) • Extensive reliability, validity, and normative database • Intelligence Tests • Nature of intellectual functioning and IQ • First tests developed by Alfred Binet • Weschler developed more tests used with adults & children • Verbal and performance domains

  10. Neurological Tests • Neurological tests are used to help diagnose cognitive impairments caused by brain damage (i.e. tumors, infections, head injury) or changes in brain activity • 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 • Magnetic resonance imaging (MRI): Utilizes strong magnetic fields & better resolution than CT scan

  11. Neurological Tests (continued) • 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; provides structural & functional images

  12. Diagnosing Psychological Disorders • Diagnosis – identifying a general class of problems together • Prognosis – likely future course of a disorder • Classification – most widely used by mental health professionals is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

  13. History of the DSM DSM-I: 1952 DSM-II: 1968 DSM-III: 1980; DSM-III-R: 1987 DSM-IV: 1994; DSM-IV-TR: 2000 DSM-5: 2013 The general consensus is that DSM-5 is largely unchanged from DSM-IV although some new disorders are introduced and other disorders have been reclassified

  14. Criticisms of the DSM-5 • 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

  15. DSM-5 Diagnostic Categories • Neurodevelopmental disorders • Elimination disorders • Disruptive, impulse-control, and conduct disorders • Schizophrenia spectrum and other psychotic disorders • Bipolar and related disorders • Depressive disorders • Anxiety disorders • Obsessive-compulsive and related disorders • Trauma- and stressor-related disorders • Dissociative disorders • Somatic symptom and related disorders • Feeding and eating disorders • Sleep-wake disorders • Sexual dysfunctions • Gender dysphoria • Substance-related and addictive disorders • Neurocognitive disorders • Personality disorders • Paraphilic disorders • Other mental disorders

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