Application of Assessment in Clinical Settings wk 11 Flashcards
(39 cards)
Distinguish testing vs assessment
Testing: the obtaining of a score that can be compared to others on the basis of normative, nomothetic findings. Only uses a single scale.
Assessment: moves beyond testing, and uses scores to devise a treatment plan and create a coherent picture of patient. Uses variety of test scores to make a judgement.
What reasons are there for asssessing someone?
- describe current functioning
- confirm,refute, or modify impressions formed by clinicians
- identify therapeutic needs, highlight issues likely to arise in treatment, recommend forms of interventions and offer guidance about likely outcomes
- aid in differential diagnosis
- monitor treatment overtime to evaluate the success of
interventions - manage risk(untoward treatment reactions,potential legal liabilities)
- provide skilled, empathic assessment feedback as a therapeutic intervention in itself.
why use standardised tests?
1) Clinicians are unreliable judges (dont always have the same judgement)
e. g. “…. We think we may say without exaggeration that these children’s diagnoses looked as if they had been drawn by chance out of a sack”
What two overarching errors do clinicians make that render them unreliable judges?
Errors in gathering data and synthesising it.
What is confirmatory evidence? How is this a ‘gathering data error?’
we make hypothesis and seek confirmatory evidence (confirmation bias). we naturally put aside evidence that doesnt support our hypothesis
Why would preconceived ideas be an error in gathering data?
Give an example.
e.g. tendency to overpathologise: because patient is coming to help, we see everything as a symptom
(ties into tendency to see patterns when none exist)
heuristics in clinical judgement:
What is anchoring? How is this an error in synthesising data?
The tendency to lock onto salient features in the patient’s presentation too early in the clinical reasoning process, and failing to adjust this initial impression in the light of later information.
Ties into confirmation bias.
heuristics in clinical judgement:
What is availability and why is it an error in synthesising data?
look for only salient evidence (seeking confirmatory evidence)
heuristics in clinical judgement:
What is representativeness and why is it an error in synthesising data ?
representativeness: look for data that matches relevant data.
What is ‘prototypes’ referring to when we talk about errors in synthesising info.
we tend to compare with examples e.g. i remember i had a patient like that perhaps i could impose the same thing.
Affect as a synthesising data error?
a we rely on feelings to interpret our data e.g. gender and race bias.
What are diagnostic interviews?
- Fully or semi-structured
- Ensure coverage of the diagnostic criteria as specified by DSM-IV/DSM-5
- Few errors in gathering data
- Rules for scoring the interview are specified
- Few errors in synthesising data
What is the name of the gold standard diagnostic interview to use?
Structured Clinical Interview for DSM-IV (SCID)
Does the SCID have high reliability and validity?
Yes.
Reliability: good…
• Inter-rater agreement
• Test-retest reliability
Validity: good…
• Validity of diagnostic criteria
What five types of tests do clinicans use ?
- Diagnostic interviews
- Self-report questionnaires
- Questionnaires completed by significant others
- Behavioural tests
- Observational methods
QUESTION MARK!
LEAD standard instead of gold standard?
prodedural validity
Look up, or ask someone! not sure!
Sensitivity?
Example of when this might be particularly helpful?
the ability of a test to predict true positives.
(Probability that a person with a clinical diagnosis will receive the same diagnostic interview diagnosis)
Used for medical tests e.g. high sensitivity in a test needed when the cost of not finding cases is high e.g. test of cancer.
Specificity?
Ability of test to exclude a true negative. If a test has
high specifiity its good at classifying those who dont have the dignosis. Needed when the cost of false posiitves is high.
(Probability that a person without a clinical diagnosis will not receive that diagnosis via the diagnostic interview)
Positive predictive values?
Proportion of people with positive who are true positive. represents presence of disease.
Probability that a person with a diagnostic interview diagnosis is truly ill
Negative predictive value?
proportion of negative results that are true negatives. Represents the absence of disease.
Probability that a person without a diagnostic interview diagnosis is truly well
What is Cohen’s kappa coefficient?
Can use if for both validity and reliability.
a statistic which measures inter-rater agreement for qualitative (categorical) items. κ takes into account the possibility of the agreement occurring by chance.
Interpretation of kappa
What would an agreement of these correlations be? .65 .56 .3 0
≥ .75 - excellent agreement .6 to .74 – good agreement .4 to .59 – fair agreement less than .4 – poor agreement 0 – agreement at chance level
Distinguish between global and specific questionnaires.
Global measures
• Assess multiple symptoms
• Provide an overall level of severity of psychopathology
(tend to be used in initial phases on contact with patient. Might be used for initial screening). Very general.
Specific measures
• Assess a limited set of symptoms
• Provide measures of the level of severity of a specified problem
(more commonly used in treatment process. And monitoring progress of client)
The Brief Symptom Inventory is an example of a global questionnaire.
What are some characteristics?
(what, no. of items, scale?, Relibability and validity adequate?, how many symptoms does it test)
Designed to reflect psychological symptom patterns of patients and non-
patients
• 53 items describing psychiatric symptoms
• Items are rated on a five-point scale indicating the level of distress each symptom has caused over the past 7 days
• 0=Not at all, 1=A little bit, 2=Moderately, 3=Quite a bit, 4=Extremely
• Adequate reliability (internal consistency and test-retest reliability) and validity (construct)
• tests 9 primary symptom dimensions
