Clinical Assessment and Diagnosis

Clinical Assessment and Diagnosis Assessing Psychological Disorders purpose of clinical assessment gather relevant info →Hx: biological, social, psychological predict behavior, ID patterns plan and select appropriate tx evaluate tx outcome diagnosis -determining whether problems meet Criteria for a psychological disorder based on DSM-5 TR analogous to a funeral • information gathering Starts broad multidimensional approach Narrow to Specific problem areas understanding presentation -Specific definition of presenting problem or symptoms (eg., depression) Key Concepts in Assessment • reliability: Consistency in measurement -ex: test-retest (across time) and inter-rater (between 2 or more raters) • Validity: degree to which an assessment measures what it is designed to measure -ex: thermometer for temperature Standardization: using same set of norms for a measurement technique to ensure it is consistently used across measurement occasions - Provides population benchmarks for comparison ex: Structured administration, scoring, and evaluation procedures Assessment: The Clinical Interview and Physical Exam •Clinical interview most Common Clinical assessment method - unstructured, Structured or semi-structured • information gathering presenting problem Current and past behavior, attitudes, emotions relevant events or Stressors - interpersonal relationsnips, Social history including family relationships and upbringing - academic, employment, criminal history • mental Status exam appearance and behavior - thought processes - mood and effect - intellectual functioning - general orientation Physical exam -refer to medical provider to R10 any potential influence on or comorbidity with presenting problem Behavioral Assessment •ongoing process before, during, after treatment how can multiple measurements help in treatment? different methods: -interview: functional analysis identifies Antecedents: what happened before, triggers Behaviors: what does it look like? Consequences: what happened afterwards • direct observations "also examines ABCs, but in the exact moment naturalistic made in the person's natural/everyday environment provides Snapshot of actual behaviors, unfiltered by self reports, inference, etc. Controlled Create Situations Similar to real environment problem of reactivity (changes in bx resulting from knowing that one is being observed) • Self-monitoring - individual observes and records own behavior, thoughts, and/or emotions Assessment: Psychological Testing • must be reliable and valid projective tests-psychoanalytic tradition based on the assumption that clients will "project" their personalities when presented with unstructured, ambiguous stimuli and an unrestricted opportunity to respond lack of objectivity in Scoring and interpretation - requires high degree of inference - considered by many to be empirically inferior to obiective tests Rorschach Inkbot method • Created by Hermann Rorschach (1921) 10 inkblots (5 in Color, 5 B+W) presented Clients say what they see in each blot (in "response" phase) -"what might this be?" later (in "inquiry "phase), explain what features of the blot caused them to make their responses • Exner's Comprenensive System is most widely used Scoring System reliability and validity are questionable and hotly debated based on Subjective interpretation of Clinicioun "Some Clinicians do not closely Follow interpretation guidelines Objective Personality Tests • include unambiguous test items, offer Clients a limited range of responses, and are Objectively scored manual Scores tell you something typically self-report questionnaires series of brief Statements or questions to which clients respond in a true/fouse or multiple choice format →"I cry often" (T/F) "I tend to be fearful of things or people" (Strongly disagree to strongly agree) Assessment: Objective Personality Tests advantages: -Standardized data collection economical and easy to administer group or individuals Computer Scoring and interpretation examples Minnesota Multiphasic Personality Inventory (MMP), MMPI-2, MMPI-1) - personality assessment inventory (PAI) extensive reliability, validity, and normative database Assessment: Neuropsychological Testing purpose and goals assesses brain dysfunction by observing its effects on a person's ability to perform tasks receptive and expressive language, attention, concentration, memory, motor Skills ex: the Luria-Nebraska and Halstead-Reitan Batteries problems false positives: positive findings that are not actually present/true false negatives: missing Something that is actually present Assessment: Neuroimaging and Brain Structure neuroimaging pictures of the brain allows for nonintrusive examination • imaging brain Structure -Computerized axial tomography (CAT or CT Scan): uses x-rays - magnetic resonance imaging (MRI) imaging brain function pasitron emission tomography (PET) Scan - functional MRI (Amrei) - brief changes in brain activity Assessment: Psycophysical psychophysiological assessment - assesses activity of the nervous system • methods - electroencephalogram (EEG) - brain wave activity heart rate and respiration - Cardiorespiratory activity electrodermal response and levels - Sweat gland activity • uses disorders involving a strong emotional component - ex: PTSD, sexual dysfunction, sleep disorders, headaches Self-Report Instruments • Self-report Checklists have been developed to quickly allow the client to report Salient Symptoms example question: - rate the extent to which you experienced difficulty concentrating (0-10 scale)