Assessment of Mental Disorders

ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ○​ Life history (past experiences) ○​ Current situation (present life and problems) ○​ Personality M3.1: ASSESSMENT OF MENTAL DISORDERS Psychological assessment – This means collecting information about a person’s traits, skills, abilities, emotions, and possible psychological problems. The goal is to understand the person better and use this information to make a psychodiagnosis. ●​ The therapist pays attention to: ○​ Verbal behavior (what the client says) ○​ Nonverbal behavior (tone of voice, facial expressions, body language) ○​ Emotions shown (anxiety, hopelessness, frustration, anger) Psychodiagnosis – This is when a clinician (psychologist, psychiatrist, or mental health professional) identifies and describes a person’s psychological symptoms. It also involves making guesses (inferences) about what might be causing the person’s distress or difficulties. Clinicians use four main methods of assessment: 1.​ Observations – Watching how a person behaves in different situations. 2.​ Interviews – Asking questions and having conversations to learn about the person’s thoughts, feelings, and history. 3.​ Psychological tests and inventories – Using standardized tools (like questionnaires or tasks) to measure traits, abilities, or symptoms. 4.​ Neurological tests – Checking the brain and nervous system to see if physical issues are affecting psychological functioning. i. ●​ They also focus on client strengths, reminding the client of their positive qualities and supportive relationships. This helps build hope and motivation. a) ●​ Observations can also be: ○​ Controlled: done in a clinic or laboratory setting. ○​ Naturalistic: done in a person’s normal environment (like home, school, or workplace). 👉 Example: A child may be observed in a classroom (naturalistic) to see how they act with other kids, or in a clinic (controlled) where a psychologist gives specific tasks and watches their behavior. INTERVIEWS ●​ In interviews, the mental health professional talks with the client to learn about their: PAGE 1 CREATED BY JEMS Types of Interviews 1.​ Structured Interview ●​ Uses a set list of questions or standardized rating scales. ●​ Very formal and consistent. ●​ Pros: Collects reliable, comprehensive information; reduces interviewer bias. ●​ Cons: Limits deeper conversation and flexibility. OBSERVATIONS ●​ Mental health professionals observe behavior while talking to or working with clients. ●​ Observations can be: ○​ Formal (structured): very specific, planned, and exact. ○​ Informal (unstructured): more casual, less exact, just noticing behaviors. ii. ●​ Interviews can also explore: ○​ Social factors (relationships, support) ○​ Sociocultural factors (culture, traditions, environment) 👉 2.​ Unstructured Interview ●​ More casual and flexible. ●​ Interviewer creates or changes questions during the conversation based on the client’s answers. ●​ Allows more in-depth exploration. Example: ●​ A structured interview might ask every client the same set of questions about their symptoms. ●​ An unstructured interview might let the therapist follow the client’s story, asking new questions as the client shares more details. b) Recording the Interview The clinician may record the interview in different ways to make sure details are not lost. This can be done by: ●​ Audio or video tape: capturing the client’s exact words, tone, and expressions for later review. ●​ Writing or taking notes: jotting down important points during the session. ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ●​ Reconstructing from memory: writing down what was remembered after the interview, though this method is less accurate. c) Sources of Salient Information during the Clinical Interview 1. History taking – This is when the clinician asks the client to share information about their past and present experiences, creating a chronological timeline of important life events. ●​ A) Personal history – This includes significant events and relationships in the client’s own life. It looks at experiences in areas such as school performance (academic struggles or achievements), peer relationships (friendships or conflicts), employment (work history, successes, or difficulties), and health (medical or psychological conditions). Personal history helps the clinician see how the client’s background shaped their current situation. ●​ B) Family history – This focuses on major events and patterns in the lives of the client’s relatives. It includes both close family members (parents, siblings) and extended family (grandparents, uncles, aunts). Exploring family history is important because family relationships, traditions, and health issues often have a strong influence on a client’s psychological well-being. 2. Mental Status Examination - This examination uses questions, observations, and tasks to quickly evaluate a client’s cognitive, psychological, and behavioral functioning. d) Mental Status Examination (Margaret’s Case Study) For Margaret (37), who was seen for severe depression, a mental status report would include the following: ●​ Appearance – Margaret showed poor self-care in grooming. Her face, hands, and hair were dirty, her shoes were only halfway on, and she had a stooped posture that made her look older. She avoided eye contact, showing clear neglect of her appearance and body language. ●​ Mood – She appeared severely depressed. Margaret confirmed this by saying she had been feeling “depressed,” “exhausted,” “hopeless,” and “worthless” for months. PAGE 2 CREATED BY JEMS ●​ Affect – This refers to the outward expression of emotions. Margaret showed minimal emotional responsiveness. Her overall demeanor was consistent with depression—flat and without energy. ●​ Speech – Her speech was slow and limited to short replies. She often answered with phrases like “I don’t know” or “I don’t care,” reflecting lack of motivation and interest. ●​ Thought Process – It was hard to evaluate her thought process because she was not very responsive. However, there was no evidence of racing thoughts or tangential thinking (jumping off-topic), which often appear in other mental conditions. ●​ Thought Content – Margaret denied hallucinations or delusions. However, she admitted that she thought about suicide almost daily, though she denied having a plan or intent to harm herself or others. She also reported constant worry about how others, especially coworkers, viewed her. ●​ Memory – Her long-term memory seemed intact, as she could recall family background, past jobs, and education. But she struggled with short-term memory, recalling only one out of three words after a 5-minute delay. ●​ Abstract Thought – Even though she was slow to respond, Margaret was able to explain proverbs such as “a rolling stone gathers no moss” and “people in glass houses shouldn't throw stones,” showing that her ability to think abstractly was still functioning. ●​ General Knowledge – Margaret could name the last four presidents, showing basic awareness, but she struggled with concentration. For example, she gave up when asked to calculate the number of nickels in $135, saying she “just can’t concentrate.” 👉 This mental status examination paints a clear picture of how depression affected Margaret’s daily functioning—from her appearance and mood to her memory and concentration. iii. PSYCHOLOGICAL TESTS AND INVENTORIES ●​ Psychological tests and inventories are standardized tools used to measure different aspects of a person, such as personality, social skills, intelligence, or career interests. ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ●​ These tests can differ in their structure (how they are designed), objectivity (how much they rely on opinion vs. facts), content (what they measure), and method of delivery (whether taken individually or in groups). a) 4. Draw-a-Person Test ●​ Example: Machover Draw-A-Person Test (1949). ●​ The client is asked to draw a person, and the examiner evaluates the drawing. ●​ Details such as the size, position, and features of the drawing are analyzed, with the assumption that they reveal aspects of the client’s personality and emotions. Projective Personality Tests In these tests, the examiner presents ambiguous stimuli—things that are unclear, like inkblots, vague pictures, or incomplete sentences—and asks the client to respond. Because the meaning is not obvious, clients are thought to project their own attitudes, unconscious conflicts, and personality traits into their answers. In this way, projective tests aim to reveal hidden needs, motivations, or worries. 1. Rorschach Test ●​ Created by Swiss psychiatrist Hermann Rorschach. ●​ Consists of 10 cards with symmetrical inkblot designs. ●​ Inkblots are used because they are ambiguous, nonthreatening, and unfamiliar, so clients cannot rely on learned responses. ●​ The examiner shows each card and asks, “What do you see in this blot?” ●​ The client’s responses are analyzed carefully—whether they notice big shapes or small details, pay attention to colors, or see movement. These answers are believed to symbolize the client’s inner motives, feelings, and conflicts. 2. Thematic Apperception Test (TAT) ●​ Developed in 1935 by Murray & Morgan. ●​ Consists of 30 picture cards, most showing two people in vague and ambiguous situations. ●​ A client is usually shown 20 cards one by one and asked to tell a story about what is happening, what led up to the scene, and what might happen next. ●​ The examiner analyzes the themes in the stories to understand the client’s personality traits, unconscious conflicts, motives, or worries. 3. Sentence-Completion Test ●​ The client is given a list of incomplete sentences such as: ○​ “My ambition …” ○​ “My mother was always …” ○​ “I can remember …” ●​ The client completes the sentences, and the examiner interprets the answers to uncover the client’s attitudes, feelings, and unresolved conflicts. PAGE 3 CREATED BY JEMS b) Self-Report Inventories Self-report inventories are psychological tools used to assess personality traits or symptoms such as depression, anxiety, or emotional reactivity. In these tests, clients either answer open-ended questions or respond to a list of self-descriptive statements about themselves. The answers are then scored and interpreted to understand the client’s psychological state. 1. The Minnesota Multiphasic Personality Inventory (MMPI) ●​ The MMPI, created by Hathaway & McKinley in 1943, is the most widely used self-report personality inventory. ●​ Its updated version, the MMPI-2 (Butcher, 1990), includes 567 true-or-false statements. The client marks each one as true or false depending on whether it applies to them. ●​ The MMPI-2 scores a person on 10 clinical scales, with each scale measuring a different psychological characteristic (for example, depression, paranoia, or social introversion). ●​ These scales were built by comparing the responses of people with diagnosed psychiatric conditions to people without mental health diagnoses. This allows the test to detect patterns linked to specific psychological disorders. ●​ Interpreting is highly complex. It requires clinicians with special training, statistical knowledge, and experience to accurately understand the meaning of the results. It is not a test that can be interpreted casually. 2. The Beck Depression Inventory (BDI) ●​ The BDI, developed by Beck, Ward, Mendelson, Mock, & Erbaugh in 1961, is a self-report test made up of 21 items. ●​ Each item measures different aspects of depression, such as mood, appetite, sleep patterns, ability to function at work, suicidal thoughts, and energy levels. ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ●​ The BDI is one of the most widely used tools for screening depression. It helps clinicians understand the severity of depressive symptoms. ●​ However, like many self-report inventories, it has limitations. Clients may overstate or understate their symptoms, consciously or unconsciously, which can affect the accuracy of the results. c) Intelligence Tests ●​ Intelligence testing is designed to estimate a person’s current level of cognitive functioning. The result is given as an intelligence quotient (IQ) score. ●​ An IQ score shows how an individual performs compared to others of the same age. The scores are standardized, with 100 as the mean (average). ●​ IQ tests are useful for predicting school performance and for detecting intellectual disability. 1. Wechsler Adult Intelligence Scale (WAIS, WAIS-IV) ●​ The Wechsler scales are among the most widely used intelligence tests. ●​ The WAIS-IV, the most recent version, is used with people aged 16 and older. ●​ It measures four main areas: ○​ Verbal Comprehension – understanding and using language. ○​ Perceptual Organization – solving puzzles and understanding visual-spatial relationships. ○​ Working Memory – holding and using information in short-term memory. ○​ Processing Speed – how quickly and accurately a person can perform simple cognitive tasks. 2. Stanford-Binet Intelligence Scale ●​ The Stanford-Binet Intelligence Scale, now in its fifth edition, is another widely used test. ●​ It can be given to individuals from ages 2 to 85, making it useful across the lifespan. ●​ Administration is somewhat complicated, as the examiner must determine: ○​ A basal age – the level at which the person passes all subtests. ○​ A ceiling age – the level at which the person fails all subtests. ●​ The test has been continually revised and updated, making it a benchmark against which other intelligence tests are compared. PAGE 4 CREATED BY JEMS Critiques of IQ Tests ●​ Some psychologists argue that IQ tests reflect cultural and social factors rather than innate intelligence. ●​ The controversial book The Bell Curve (Herrnstein & Murray, 1994) claimed that: ○​ People of different races score differently on IQ tests. ○​ These differences are mostly because of genetics (something you are born with). ○​ Because of this, they suggested that these IQ gaps are very hard or impossible to change. ●​ Similar claims were made later by Richwine (2009) regarding Hispanic immigrants. ○​ He claimed their IQ scores are lower than white native populations. ○​ He also suggested that their children and grandchildren would continue to have low IQs, even after living in the U.S. ●​ Many psychologists and researchers strongly disagree with these claims because: ○​ They ignore outside factors that affect IQ test performance. ○​ Things like culture, poverty, discrimination, and oppression can lower someone’s test results. ➔​ For example: ○​ A child growing up in poverty may not get good nutrition, education, or learning opportunities. ○​ A person facing discrimination might experience stress or lower self-esteem, which can hurt performance. ○​ Cultural differences (like the way questions are asked) can favor some groups over others. Alternative Views on Intelligence ●​ Many researchers believe that intelligence is more than just what IQ tests measure. Standard IQ tests mostly look at narrow skills, so they don’t capture the full picture of a person’s abilities. ●​ One well-known psychologist, Sternberg (2004), explained intelligence in three parts: 1.​ Analytical proficiency - Being good at solving problems, analyzing situations, and making decisions. This is what most IQ tests usually focus on. ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS 2.​ Creativity - Being able to come up with new, original, and interesting ideas. This part of intelligence is often ignored in IQ tests. ●​ Purpose: It gives quick clues about possible brain dysfunction affecting visual and motor coordination. 3.​ Practical skills - Knowing how to handle real-life situations and adapt to daily challenges. For example, figuring out how to fix something broken or managing your time well. 2. Halstead-Reitan Neuropsychological Test Battery ●​ What it is: A set of 11 different tests designed to check brain functioning. ●​ What it measures: ○​ Sensorimotor skills – movement, coordination, reaction. ○​ Cognitive abilities – memory, focus, problem-solving. ○​ Perceptual skills – how well a person understands what they see or hear. ●​ Other researchers, like Nisbett (2005) and Suzuki & Aronson (2005), argue that IQ tests do not actually measure a person’s natural intelligence. They also say that IQ is not a strong predictor of success in real life. ●​ Instead, qualities such as motivation, hard work, and perseverance often matter more. For example, someone with average IQ but strong determination can achieve more in school or career than someone with high IQ but little effort. d) ●​ Strengths: ○​ Can identify whether brain damage exists. ○​ Can show the type of brain damage and sometimes the location. Tests for Cognitive Impairment These tests are used by clinical psychologists (especially in hospitals) to check if a person has cognitive problems caused by brain damage. Brain damage can affect both physical skills (like movement and coordination) and mental skills (like memory, focus, and learning). 1. Bender-Gestalt Visual-Motor Test ●​ What it is: The person is shown 9 simple geometric designs (like shapes or patterns) and asked to copy them onto paper. ●​ Limitations: ○​ Takes over 6 hours to complete. ○​ Very expensive and time-consuming, so it’s not always practical for every patient. iv. These tests help doctors and researchers understand and diagnose problems in the brain. They are especially useful for studying psychiatric disorders (like depression, schizophrenia) and neurocognitive disorders (like dementia, brain injury). ●​ Why it’s used: If someone has brain impairment, they may make specific mistakes when drawing. ●​ Common errors that suggest impairment: ○​ Rotation of figures – drawing the shapes tilted or turned incorrectly. ○​ Perseveration – continuing a pattern or repeating parts of the design unnaturally. ○​ Inability to copy angles – difficulty in drawing sharp corners or exact shapes. NEUROLOGICAL TESTS ●​ They use neuroimaging: ○​ Structural imaging → shows the physical structure of the brain (like taking a photo of the brain). ○​ Functional imaging → shows how the brain is working in real-time (like watching a video of brain activity). a) Structural Imaging Techniques 1. Computerized Axial Tomography (CT scan) ●​ What it is: A CT scan takes many X-ray images from different angles and combines them into a 3D picture of the brain. ●​ Uses: Helps doctors find tumors, bleeding, brain injuries, or abnormalities in structure. ●​ Strengths: ○​ Widely available in hospitals. ○​ Quick and effective for emergencies (e.g., checking for stroke or bleeding). ●​ Limitations / Risks: PAGE 5 CREATED BY JEMS ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ○​ Involves radiation exposure (which can increase the risk of cancer). ○​ Especially risky for children—studies show that children who undergo multiple CT scans have a 3x higher risk of developing leukemia or brain cancer later. 2. Magnetic Resonance Imaging (MRI) ●​ What it is: Uses magnetic fields and radio waves instead of X-rays to create highly detailed images of the brain. ●​ How it works: Scans the brain layer by layer, producing sharp cross-sectional images. These images can look almost like actual brain slices from an autopsy but without surgery. ●​ Strengths: ○​ No radiation, so it’s safer than CT scans. ○​ Produces clearer and more detailed images of brain tissue, making it better for spotting small abnormalities. ●​ Limitations: ○​ More expensive than CT scans. ○​ Less widely available, especially in smaller hospitals or rural areas. ○​ Some patients may find it uncomfortable (the machine is loud, and the patient must lie still inside a narrow tube). b) Functional Imaging Techniques Unlike structural imaging (which shows the brain’s physical shape), functional imaging shows what the brain is doing in real time—its activity, communication, and energy use. 2. Magnetoencephalography (MEG) ●​ What it is: Similar to EEG, but instead of measuring electrical activity directly, it measures the magnetic fields created by brain activity. Electrodes are placed in a helmet-like device. ●​ Strengths: ○​ More precise than EEG in pinpointing where brain activity is happening. ●​ Limitations: ○​ Like EEG, it mainly captures activity near the surface of the brain, not deeper areas. 👉 Think of MEG as a “magnetic detector” that listens to brain activity more precisely than EEG. 3. Positron Emission Tomography (PET) ●​ What it is: Involves injecting a tiny amount of radioactive glucose (sugar) into the bloodstream. ●​ What it shows: Since active brain areas use more glucose, the scanner highlights which parts of the brain are working hardest. ●​ Uses: ○​ Detects tumors, diseases, and abnormal activity. ○​ Used in research to see how treatments (like therapy or medication) change brain activity. ●​ Limitations: ○​ Involves radioactivity, so it carries some health risks. ○​ More expensive than EEG or MEG. 1. Electroencephalograph (EEG) ●​ What it is: Small electrodes are attached to the scalp to record electrical activity in the brain. 👉 Think of PET as “feeding the brain glowing sugar” and watching which areas light up the most. ●​ What it shows: Brain wave patterns, such as when someone is awake, asleep, or having a seizure. 4. Functional Magnetic Resonance Imaging (fMRI) ●​ What it is: A newer, noninvasive method that uses magnets (like MRI) but tracks blood flow and oxygen use in the brain. ●​ Strengths: ○​ Can detect very brief, sudden changes in brain activity (like seizure activity). ○​ Non-invasive and relatively inexpensive. ●​ Limitations: ○​ Can only measure activity on the surface of the brain, not deep inside. 👉 Think of EEG as a “microphone” placed on the outside of the head to listen to the brain’s electrical signals. PAGE 6 CREATED BY JEMS ●​ What it shows: Reveals which brain regions are active at any given time, since active neurons need more oxygen. ●​ Strengths: ○​ Provides both a clear image of brain structures and activity in real-time. ○​ No radiation exposure. ●​ Limitations: ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ○​ More expensive and less available than EEG. ○​ Requires lying still in a loud, narrow scanner. ➔​ When neuroimaging is combined with other types of assessments (like interviews, psychological tests, or neurological exams), it gives a much more complete picture of the person. This combined approach helps us connect biological processes (like brain activity or blood flow) with psychological processes (like emotions, thinking, or behavior). 👉 Think of fMRI as a “live video” of the brain showing where energy is being used. 5. Diffusion Tensor Imaging (DTI) ●​ What it is: A special type of MRI that tracks how water molecules move through the brain. ➔​ Some scientists even believe that in the future, these imaging tools will allow clinicians to make faster and more accurate diagnoses. They may also guide doctors in choosing the best treatment for each individual, since brain scans can show how someone is responding to therapy or medication. ●​ What it shows: Provides detailed images of axons (nerve fiber pathways)—the “wiring” that connects different brain regions (white matter). ●​ Uses: ○​ Helps doctors see if communication pathways are damaged (e.g., after stroke, trauma, or in disorders like multiple sclerosis). ●​ Strengths: ○​ Shows connections and networks, not just isolated regions. 👉 Think of DTI as a “map of brain highways,” showing how different brain areas are connected. In summary: ●​ EEG & MEG = record electrical/magnetic activity (good for surface-level, moment-to-moment changes). ●​ PET = uses radioactive glucose to show where the brain is most active. ●​ fMRI = noninvasive, tracks oxygen use to show active brain regions. ●​ DTI = maps the brain’s wiring and connections. ➔​ Neuroimaging techniques, whether used alone or together, give doctors and researchers a way to look at brain problems and study how the brain works in people with mental disorders. Each technique has its own strengths and weaknesses—some are more expensive, some are safer, and some provide clearer details. Because of this, doctors have to carefully weigh the risks and benefits before deciding which technique to use for research, diagnosis, treatment planning, or tracking how a disease is progressing. ➔​ Thanks to these brain imaging tools, our understanding of the brain has grown a lot, especially in conditions like schizophrenia, depression, bipolar disorder, Alzheimer’s disease, and substance abuse. They help us see not just the brain’s structure but also its activity patterns, which are often very different in people with these disorders. PAGE 7 CREATED BY JEMS M3.1: CLASSIFICATION OF MENTAL DISORDERS i. DIAGNOSING MENTAL DISORDERS Once all the assessment information (from interviews, tests, observations, etc.) is collected, clinicians use a classification system to make a diagnosis. A classification system organizes abnormal behaviors into clear categories, with each disorder having its own set of symptoms, causes, and patterns. You can think of it like a catalog or manual—each disorder has a description that makes it different from other disorders. a) The DSM (Diagnostic and Statistical Manual of Mental Disorders) ●​ The DSM is the most widely used classification system for mental disorders. ●​ It lists every officially recognized mental disorder and the specific symptoms needed for diagnosis. ●​ These criteria can include physical signs (like sleep problems), behaviors (like social withdrawal), and emotional issues (like sadness or fear). ●​ Importantly, for any disorder to be diagnosed, symptoms must cause serious distress or problems in daily life (work, school, relationships, etc.). ●​ The DSM affects not only clinicians but also: ○​ Patients/consumers (how their struggles are understood), ABNORMAL PSYCHOLOGY C-PSYM221 1ST SEMESTER – MIDTERMS ○​ Health care providers (how they plan treatment), ○​ Insurance companies (what treatments they agree to cover), ○​ Pharmaceutical companies (which medications are developed and marketed). Historical Roots: Emil Kraepelin The DSM is based on the ideas of Emil Kraepelin (around 1850). He believed that mental disorders are like physical illnesses, with 1each disorder having a specific symptom pattern. ●​ This made the DSM a categorical system: people are diagnosed as either having or not having a disorder. ●​ Example: Like diagnosing pneumonia, the clinician looks for a checklist of symptoms to confirm the disorder. But diagnosing mental disorders is more complicated because: ●​ Disorders often have overlapping symptoms. ●​ Example: Depression and anxiety share many signs (like sleep problems, concentration issues, restlessness). They even respond to the same medications, making it hard to separate them cleanly. b) The ICD (International Classification of Diseases) ●​ Another important classification system is the ICD, managed by the World Health Organization (WHO). ●​ Unlike the DSM, which only covers mental disorders, the ICD covers all medical conditions (including mental health). ●​ In recent years, DSM and ICD definitions of mental disorders have become more similar, but they still have some important differences in how they define and group disorders. PAGE 8 CREATED BY JEMS