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Chapter 3

Chapter 3. Clinical Assessment and Diagnosis. Assessing Psychological Disorders. Purposes of clinical assessment To understand the individual To predict behavior To plan treatment To evaluate treatment outcome

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Chapter 3

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  1. Chapter 3 Clinical Assessment and Diagnosis

  2. Assessing Psychological Disorders • Purposes of clinical assessment • To understand the individual • To predict behavior • To plan treatment • To evaluate treatment outcome • Diagnosis – the process of determining whether the individual meets the criteria for a psychological disorder

  3. 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

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

  5. The Clinical Interview and Physical Exam • Clinical interview • Most common clinical assessment method • Structured or semi-structured

  6. The Clinical Interview and Physical Exam • Mental status exam • Appearance and behavior • Thought processes • Mood and affect • Intellectual functioning • Sensorium • Semistructured clinical interviews (DICA, ADIS - IV) • Physical exam

  7. 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 • ABCs – Identify antecedents, behaviors, and consequences

  8. ABC Chart

  9. Behavioral Assessment and Observation • Behavioral observation and behavioral assessment • Can be either formal or informal • Self-monitoring vs. being observed by others • Problem of reactivity using direct observation • Behavior Rating Scales • Expanded Brief Psychiatric Rating Scale

  10. Rorschach Inkblot Test 10 inkblots - designed by Hermann Rorschach. 1884-1922

  11. Thematic Apperception Test (TAT) Developed by Henry Murray (1893-1988),

  12. Psychological Testing and Objective Tests • Objective tests • Roots in empirical tradition • Test stimuli are less ambiguous • Require minimal clinical inference in scoring and interpretation • Personality tests • Minnesota Multiphasic Personality Inventory (MMPI) • Extensive reliability, validity, and normative database

  13. Psychological Testing and Objective Tests • Intelligence tests • Nature of intellectual functioning and IQ • The deviation IQ • Verbal and performance domains • Stanford-Binet V • WPPSI – III • WISC – IV • WAIS - III

  14. Neuropsychological Testing • Purpose and goals • Assess broad range of skills and abilities • Goal is to understand brain-behavior relations • Examples • NEPSY • The Delis-Kaplan Executive Function System • Problems • False positives • False negatives

  15. Electroencephalograph(EEG) Positron emission tomography(PET) Computed tomography(CT) Magnetic resonance Imaging (MRI) The EEG has been admitted in court as another method of lie detection, alternately referred to as “brain fingerprinting.” Peeking Inside the Brain fMRI

  16. Psychophysiological Assessment • Uses of routine psychophysiological assessment • Disorders involving a strong emotional component • Examples • PTSD, sexual dysfunctions, sleep disorders • Headache and hypertension

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

  18. Diagnosing Psychological Disorders: Foundations in Classification • Idiographic strategy • What is unique about an individual’s personality, cultural background, or circumstances • Nomothetic strategy • Identifying a specific psychological disorder, to make a diagnosis

  19. Diagnosing Psychological Disorders: Foundations in Classification • Terminology of classification systems • Taxonomy – classification in a scientific context • Nosology – taxonomy in psychological/medical phenomena • Nomenclature – nosological labels (e.g., panic disorder)

  20. Issues with Classifying and Diagnosing Psychological Disorders • Categorical and dimensional approaches • Classical (or pure) categorical approach – strict categories • Dimensional approach – classification along dimensions • Prototypical approach – combines classical and dimensional views

  21. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) LO 14.3 What are the different types of psychological disorders?

  22. Report disorders/conditions requiring clinical attention Axis I Clinical Disorders Maladaptive personality traits and brain development issues Axis II Personality & Retardation Medical conditions that affect a mental disorder Axis III General Medical Social & environmental problems impacting treatment Level of functioning in daily living Axis V Global Function Axis IV Psychosocial & Environment

  23. DSM-IV-TR Axes

  24. Axis I Disorders

  25. 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 • DSM-5 • Due out May 2013

  26. 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.

  27. Basic Components of Research • 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

  28. 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

  29. Statistical versus 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

  30. Statistical versus Clinical Significance • Balancing statistical versus clinical significance • Evaluate effect size • Evaluate social validity • Generalizability and the patient uniformity myth • The “average” client

  31. 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

  32. 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

  33. Research by Correlation • 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

  34. Research by Experiment • Epidemiology • the study of the incidence, distribution, and consequences of a particular problem or set of problems in one or more populations

  35. 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

  36. Research by Experiment • Comparative treatment designs • Type of group design • Compare different forms of treatment in similar persons • Addresses treatment process and outcome

  37. 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

  38. Genetic Research Strategies • Strategies used in genetic research • Family studies – behaviors/emotional traits in family members • Adoptee studies – separate environmental from genetic factors • Twin studies – psychopathology in fraternal vs. identical twins • Genetic linkage and association studies – sites of defective genes

  39. Studying Behavior Over Time • Time-based research strategies • Cross-sectional designs and the cohort effect • Longitudinal designs and the cross-generational effect • Sequential designs – combine both strategies • Assets and liabilities of time-based research strategies

  40. Figure 1.6

  41. The Nature of Programmatic Research and Research Ethics • Research ethics: institutional review boards (IRB) & the APA ethics code • Informed consent –Competence – ability to provide consent • Voluntarism – lack of coercion • Full information – necessary information to make an informed decision • Comprehension – understanding about benefits and risks of participation

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