assesment, diagnosis and modern treatments Flashcards
assesment: the clinical interview
what do they usually ask?
- Used by psychologists, psychiatrists, mental health professionals
- Current and past behaviour, attitudes, and emotions
- Detailed history of individual’s life in general and presenting problem
- Current and past interpersonal/social history
- Information on upbringing, sexual development, religious attitudes, cultural factors
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The clinical interview is used by psychologists, psychiatrists, and other mental health professionals. The interview gathers information on current and past behaviour, attitudes, and emotions, as well as a history of the individual’s life in general and of the presenting problem. Clinicians determine when the presenting problem first started and identify other events (e.g., life stress, trauma, physical illness) that might have occurred about the same time. In addition, most clinicians gather at least some information on the patient’s current and past interpersonal and social history, including family makeup (e.g., marital status, number of children, student currently living with parents), and on the individual’s upbringing. Information on sexual development, religious attitudes (current and past), relevant cultural concerns (such as stress induced by discrimination), and educational history are also routinely collected. To organize information obtained during an interview, many clinicians use a mental status exam.
assesment: the clinical interview
the mental status exam
In essence, the mental status exam involves the systematic observation of somebody’s behaviour. In the mental status exam, clinicians organize their observations in a way that gives them sufficient information to determine whether a psychological disorder might be present. For the most part, the exams are performed relatively quickly by experienced clinicians in the course of interviewing or observing a patient.
The exam covers five categories:
1) Appearance and behaviour: any overt behaviours, such as leg twitching, dress, general appearance, posture, and facial expression.
2) Thoughts/thought processes: When clinicians listen to a patient talk, they’re getting a good idea of that person’s thought processes. They might look for several things here. For example, does the person talk really fast or really slowly? Do the patients make sense when they talk or are ideas presented with no apparent connection? In some patients with schizophrenia, a disjointed speech pattern, referred to as looseness of association, may be noticed. In addition to rate or flow and continuity of speech, what about the content? Is there any evidence of delusions (distorted views of reality)?
3) Mood/affect: ood is the predominant feeling state of the individual, as we noted in Chapter 2. Do the patient appear to be down in the dumps or continually elated? Do they talk in a depressed or hopeless fashion? Are there times when the depression seems to go away? Affect, by contrast, refers to the feeling state that accompanies what we say at a given time. If a friend told you their mother has died and is laughing about it, or if your friend has just won the lottery and is sobbing, you would think it inconsistent. A mental health clinician would note that your friend’s affect is inappropriate.
4) Intellectual functioning: linicians make a rough estimate of others’ intellectual functioning just by talking to them. Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors (as most of us do much of the time)? How is the person’s memory? We usually make some gross or rough estimate of intelligence that is noticeable only if it deviates from what is typical, such as concluding the person is above or below average intelligence.
5) Sensorium: Sensorium is our general awareness of our surroundings. Does the individual know what the date is, what time it is, where they are, who they are, and who you are? People with permanent brain damage or dysfunction—or temporary brain damage or dysfunction, often caused by drugs or other toxic states—may not know the answer to these questions. If the patient knows who he or she is and who the clinician is and has a good idea of the time and place, the clinician would say that the patient’s sensorium is clear and is oriented times three (to person, place, and time).
clinical interview approaches
what are the different interview structures?
in general interviews will ask about symptoms to get a sense of what is going one, ask questions about developmental history, educational background, social life, medication, symptom, gather information from all those areas
unstructured interviews: follows no systematic format and would ask questions above
Problem with unstructured: very easy to miss things, overlook potential explanations, confirmation bias (this sounds like xyz, they would ask questions things that will confirm their beliefs, so they overlook any potential explanations) practitioners often overvalue their expertise
semistructured: Semistructured interviews are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner, so clinicians can be sure they have inquired about the most important aspects of particular disorders. Clinicians may also depart from set questions to follow up on specific issues
- basically a general guideline to follow that they can deviate off of as needed, series of questions u go through and the ycan go off with those gudielines if necessary. See more in a therapy session
- disadvantage: The disadvantage, of course, is that it robs the interview of some of the spontaneous quality of two people talking about a problem. Also, if applied too rigidly, this type of interview may inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked.
structured: step by step interviews, intensive, lots of details, full coverage, structure interviews are rigid stepby step that are designed high accuracy. Good for research.
physical examination
f the patient presenting with psychological problems has not had a physical exam in the past year, a clinician might recommend one, with particular attention to the medical conditions sometimes associated with the specific psychological problem. Many problems presenting as disorders of behaviour, cognition, or mood may, on careful physical examination, have a clear relationship to a temporary toxic state. This toxic state could be caused by bad food, the wrong amount or type of medicine, or the onset of a medical condition. For example, thyroid difficulties, particularly hyperthyroidism (overactive thyroid gland), may produce symptoms that mimic certain anxiety disorders, such as generalized anxiety disorder. Hypothyroidism (underactive thyroid gland) might produce symptoms consistent with depression. Certain psychotic symptoms, including delusions or hallucinations, might be associated with the development of a brain tumour. Withdrawal from cocaine often produces panic attacks, but many patients presenting with panic attacks are reluctant to volunteer information about their addiction, which may lead to an inappropriate diagnosis and improper treatment.
Usually, psychologists and other mental health professionals are well aware of the medical conditions and drug use that may contribute to the kinds of problems described by the patient. If a current medical condition or drug use situation exists, the clinician must ascertain whether it is merely co-existing or causal, usually by looking at the onset of the problem. If a patient has experienced severe bouts of depression for the past five years but within the past year also developed hypothyroid problems or began taking a sedative drug, then we would not conclude the depression was caused by the medical or drug condition. If the depression developed simultaneously with the initiation of sedative drugs and diminished considerably when the drugs were discontinued, we would be likely to conclude the depression was part of a substanceinduced mood disorder.
assessment: the clinical interview
which part of mental status exam is being assessed?
- During the interview, the clinician pays close attention to the client’s speech pattern, noting things like speed, content, and continuity. There were no indications of delusions. -> THOUGHT PROCESSES
2.The clinician made observations about the patient’s disheveled attire, noting that the man frequently averted his gaze and appeared to be irritable. -> APPEARANCE AND BEHAVIOUR
- After an athlete sustained a serious head injury, the clinician asked the athlete to report the date, time, and her name. -> SENSORIUM
- While describing a near-fatal accident, the client laughed and was noted by the clinician to appear elated. -> MOOD AND AFFECT
- The clinician asked the client to recall details of some recent events and also noted the client had an adequate vocabulary. -> INTELLECTUAL FUNCTIONING
behavioural assesment
The mental status exam is one way to begin to evaluate how people think, feel, and behave and how these actions might contribute to or explain their problems. Behavioural assessment takes this process one step further by using direct observation to formally assess an individual’s thoughts, feelings, and behaviour in specific situations or contexts; this information should explain why the person is having difficulties at this time.
linical interviews sometimes provide limited assessment information. Young children or individuals who are not verbal because of the nature of their disorder or because of cognitive deficits or impairments are not good candidates for clinical interviews. As we already mentioned, sometimes people deliberately withhold information because it is embarrassing or because they aren’t aware that it is important. In addition to talking with a client in an office about a problem, some clinicians may go to the person’s home or workplace or even into the local community to observe the person and the reported problems directly. Others set up role-play simulations in a clinical setting to see how people might behave in similar situations in their daily lives.
assessment: behavioural assessment
direct observations
Abc’s of observation
create measurable goals for treatment
self-monitoring and reactivity
Direct observation to gather information – we may directly observe the person to gather information abt thoughts feelings and behaviours, in their sort of environment
In behavioural assessment, traget behaviours are identified and observed with the goal of determining the factors that seem to influence those behaviours.
ABC’s of observation – primarily interested in this. Antecedent, behaviour and consequence of the behaviour and this can form a lot of intervention
Advantage is it allows us ti gather information abt people who may not be able to verbalize their issues (example: children who has verbal deficits,autism, cognitive deficits) another advantage is we can gather information abt people who maybe withholding info or just not aware (we can observe ppl in the workplace, at home, memory is starting to diminish, parents not wanting to report their children’s behaviour, )
In this case behavioral assessment can be useful for phobias, anxiety disorders (they can engage in that situation and look at the abc set)
Self monitoring is godo for phobias
Reactivity – change in a behaviour due to monitoring it , thoughts and emotions may shift just by having awreness
The ABCs of Observation
Observational assessment is usually focused
1) Antecedents: Immediate behaviour, its antecedents (what happened just before the behaviour)
2) Behaviour
3) Consequences: what happened afterward
To use the example of the young boy, an observer would note that the sequence of events was: (1) his parent asking him to put his glass in the sink (antecedent), (2) the boy throwing the glass (behaviour), and (3) his parent’s lack of response (consequence). This sequence (the ABCs) might suggest that the boy was being reinforced for his violent outburst by not having to clean up his mess. And because there was no negative consequence for his behaviour (his parent didn’t reprimand him), he will probably act violently the next time he doesn’t want to do something
assessment: psychological testing
projective tests
Still commonly used despite poor theoretical and psychometric support
Rorschach Inkblot Test
Projective tests – not reliable or valid
Based on psychoanalytic theory – premises that ppl will project our true personality, unconscious fears and thoughts onto the ambiguous test stimuli and therefore reveal these hidden unconscioys thoughts
through these poctures Reveals unconscious thoughts to ur therapist
Generalkly does not work , does not relate to any measures of personality, low reliability overtime (multiple assesos interpreting the findings and u will mosy likely not get the same results) , doesn’t help diagnose people
At best can be a pount of discussion but not for any meaningful interpretations
Do not rely on these ti establish osychopatjology
projective testing
We saw in Chapter 1 how Freud brought to our attention the presence and influence of unconscious processes in psychological disorders. At this point we should ask, “If people aren’t aware of these thoughts and feelings, how do we assess them?” To address this intriguing problem, psychoanalytic workers developed several assessment measures known as projective tests. They include a variety of methods in which ambiguous stimuli, such as pictures of people or things, are presented to a person who is asked to describe what they see. The theory here is that people project their own personality and unconscious fears onto other people and things—in this case, the ambiguous stimuli—and, without realizing it, reveal their unconscious thoughts to the therapist.
assessment: psychological testing
projective tests
1) Thematic Apperception Test (TAT)
- tell story about ambiguous picture
perhaps the best-known projective test, after the Rorschach. It was developed in 1935 by Morgan and Murray (Bellak, 1975). The TAT consists of a series of 31 cards: 30 with pictures on them and 1 blank card, although only 20 cards are typically used (see ■ Figure 3.5). Unlike the Rorschach, which involves asking for a straightforward description of what the test taker sees, the instructions for the TAT ask the person to tell a dramatic story about the picture. The tester presents the pictures and tells the client, “This is a test of imagination, one form of intelligence.” The person being assessed is asked to “let your imagination have its way, as in a myth, fairy story, or allegory” (Stein, 1978, p. 186). Again like the Rorschach, the TAT is based on the notion that people will reveal their unconscious mental processes in their stories about the pictures (Nissley & DeFreese, 2020).
- can be used as an icebreaker, for getting people to open up and talk about how they feel about things going on in their lives
- Their relative lack of reliability and validity, however, make them less useful as diagnostic tests. Concern over the inappropriate use of projective tests should remind you of the importance of the scientist–practitioner approach. Clinicians not only are responsible for knowing how to administer tests but also need to be aware of research evidence about their usefulness as a means of diagnosing disorders.
2) Draw-a-Person Test
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They all present ambiguous picture and asked to tell a story (beginning, middle in the end)
Someone will interpret ur stiry with no guidelines to the test administrator, so its not reliable, not valid it may be able to predict a need for achievement
There’s nothing here to substantaiate it
Draw a person test – ask someone to draw ur family, then someone would interpret it, no guidelines to make valid measures, could be use as a discussion starter / conversation starter, but not useful to understand psychopathology or someone’s personality, do not use for any meaninglful interpretation
psychological testing
multidimensional instruments
Many types of symptoms (200-600 items)
Often include validity scales
> Positive impression management
>Negative impression management
> Random responding
Comparison to norms
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Personality tests in the textbook – pretty inaccurate, they are measures of psychopathology
Multidimensional instruments - Ask questions related to many types od symptoms, they can asses an individual’s response pattern to see whether or not they are leaning towards ___ to gather info
Positive impression – when ppl try to obhere better than they are, series of questions on scenarios, and they have baseline for how ppl typically respond, superhuman, never report having diffuclty, challenges when the general population experience this
Negative impression – that’re malingering , trying to make their actual symptoms far worse, (when trying to prove insanity in court, gain access to services prescriptions and therapy)
Random responding – is this person just randomly
Overall they are long, can induce fatigue in clients, they can detect protocol validity, they can detect malingering and concealment and theres liteaturtu to support
psychological testing
multidimensional instruments
MMPI-3
Developed using the empirical method
8 Restructured Clinical Scales
26 Specific Problems Scales (somatic/cognitive, internalizing, externalizing, & interpersonal
10 validity scales
335 T/F Items
Good reliability and predictive validity
No underlying theory, item overlap amongst scales
MMPI-3 notes
MMPI-3
New – know abt it
Original mmpi was developed on a scale scale basis on the 1930s – early 1940s
This one was based on an empirical method to develop clinical scales – derive tby selecting items/ questions that wwre endorsed by patients known to have been diagnosed with a disorder
despression for example
They typically have a question that depressed people would say yes to that question
Look at the general population and the ydecide what symptoms they endorse, what they have (very a-theoretical) what do people say in the population say they have, wasn’t based on a theory instead look at people with psychopatholgy
This type od development – questions are meaningful
In this new version, just know that the;res a lot of validity scales, they cut down on questions, t/f questions is unique
Predictive validity –
Mmp1 3 has advnatges now, expanded on normative people, a greater representation of the adult population, more arranged on demographic, gender diversity,
No underlying theory, item overlap amongst scales – items overlap (synptoms of anxiety and depression may overlap) there is some overlap in questiins
Item iverlap may be Problematic because it may be difficukt at times, not be clear on interpretatiins
not really a personality scale because the main focus is on psychopathology and not personality
psychological testing
multidimensional instruments
PAI
Developed using a construct validation approach
344 items, 4-point scale
11 symptom scales, 4 validity scales
Good reliability, predictive validity, construct validity, and discriminant validity
Extensive psychometric testing and theoretical support
PAI notes
PAI
This would be the biggest competitor to the
This asses psychopathology like mmpi
Construct validation approach – theory driven, the researches had constructs or theory about depression and all of those aspects related to thoughtsm heaviours, and then make questions of how they view depression oppose to asking people
Come up with a construct first then create questions
Lots of symptom scales, some of validity scales, but has good reliability and validity
Similar to the other test, u wont get people to do both – can be exhausting
PIA has advanatges – has 4 point likert scale, give u more information that way
*** No item overlap – big advantage, if someone endorses tha tquestion its only applkying to one symptom scale, its easier to interpret bu thas pure validity indicators which can be a disadvantage
** BASED ON A CONSTRUCT VALIDATION APPROACH, VERY A THEORETICAL
multidimensional tests - exhausting but can give lots of information
psychological testing
brief scales
More depth, but less breadth
Multiple symptoms (e.g., IDAS-II)
Specific symptoms (e.g., BAI & BDI)
Etiological factors (e.g., WW-II)
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Brief scales to diagnose or look for symptoms
Overall they measure a few clases of symprtoms, much easier for clients to complete and a lot easier,
Less breadth (they go deeper not wider)
IDAS – for multiple symptoms, much shorter, they don’t typically have validity measures, useful for treatment progrwss as oppose to diagnosing
Bai ans bdi –focused in very specific symotomps,
Etiological factors – things that are leading to the symptoms, measuring beliefes abt theirworry (ww11), most useful for monitong sympotoms overtime
explain the benefits of administering neuropsychological testing, neuroimaging, and psychophysiological assessment to individuals with psychological disorders.
see tectbook
assessment: neuropsychological testing
Language, attention, memory, motor skills, perception, etc.
Intelligence testing
> E.g., WAIS, WISC, WPPSI
The Bender-Gestalt
> Brain trauma, perceptual distortions, psychotic disorders
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Neurpsych testibg will look at receptive and experessive languange, attention and concentration, motor skills, perceptual abilities, intelligence testing
Intelligence measures are typically used for diagmosing LD, can also be used when an individual is trying to asses brain trauma, effect of drugs,
Bedner-gestalt – was used to asses brain trauma, psychotic disorder, individual is given pcitures of geographic visual figures sand they try to recreate it , are they paying attention, not good for diagnosting, no reliability, low validity, can be useful as a screening tool, otherwise not super useful
