Assessment and Diagnosis (Week 3)

Question 1

Standardization

Answer 1

Responses of the person being assessed are compared to test
norms that have been established

Question 2

When selecting norms…

Answer 2

1. should be as representative of the general population as possible
2. should represent the specific subgroup to which the individuals belongs

Question 3

Stratified General Population Norms

Answer 3

norms based on a sample of the general population that has been stratified (divided) according to key demographic variables such as age, gender, education level, and race/ethnicity, so that the sample reflects the overall population distribution
ex. A 70-year-old woman with 10 years of education scores in the 30th percentile compared to the general population

Question 4

Demographically corrected norms (within-group norms)

Answer 4

• When you’re interested in comparing an individual’s score to a group of people of the same age, gender, education, handedness, ethnic
  group, geographic location, etc
  ex. Compared to others her age and education level, her score is in the 55th percentile, suggesting her performance is normal for her demographic group

Question 5

Clinical Interview

Answer 5

• conversation between a clinician and a client that is aimed at determining diagnosis, history, causes for problems, and possible treatment options
• things left unsaid + emotion/affect + behaviours are equally important
  2 Types:
  1. Structured
  2. Unstructured

Question 6

Structured interviews

Answer 6

• questions are structured ahead of time in a prescribed fashion
• Branching interviews
  are ones in which a client’s response to one questions determines the next

Question 7

Unstructured interviews

Answer 7

• Questions not structured ahead of time
• Often more prone to variability due to interviewer expertise, bias, etc

Question 8

Psychological tests

Answer 8

• standardized procedures designed to measure a person’s performance on a particular task or to assess his or her personality, or thoughts, feelings, and behaviour
• if the results of a diagnostic interview are inconclusive, psychological tests can provide information that can be used in a supplementary way to arrive at a diagnosis

Question 9

Screening Measures

Answer 9

• psychological test
• brief, standardized psychological tests or questionnaires used to identify individuals who may have or be at risk for a particular psychological disorder or concern
  ex. Beck Scales
  GAD-7 (generalized anxiety disorder)
  PHQ-9 (patient health questionnaire)

Question 10

Rorschach Inkblot Test

Answer 10

• projective test in which the subject is instructed to interpret a series of ten inkblots
  (monochromatic and coloured)
• soliciting a number of
  responses, and then afterwards asking the person to explain their answer(s)
• Scored on a variety of elements including:
  a)number of response, b) “popularity” of response
  c) response to colour = indicative of emotional
  control
  d) shading = anxiety
  e) focus on space = hostility

Question 11

The Thematic Apperception Test

Answer 11

• projective test
• et of 31 black-
  and-white pictures reproduced on cards, each depicting a potentially emotion laden situation
• examinee instructed to make up a story about each situation
• actual subset of cards is personalized for the individual
• Look for and interpret in regards to consistent or unusual thematic content

Question 12

Projective Hypothesis

Answer 12

notion that highly unstructured stimuli are necessary to bypass defenses in order to reveal unconscious motives and conflicts

Question 13

Projective techniques

Answer 13

• Tests of personality that involve use of unstructured stimulus materials
• Use of such materials maximizes the role of internal factors such as emotions and
  motives in perception
  ex. Rorschach Inkblot Test and Thematic Apperception Test (TAT)

Question 14

Pros and Limitations of Psychological Screening Measures

Answer 14

Pros
- quick to administer
- Cheap/free / often in the public domain
- Help with early identification
Limitations
- Incomprehensive & not diagnostic
- prone to False positives
- prone to false negatives

Question 15

Specific psychological inventories

Answer 15

• standardized self-report tools designed to measure particular psychological traits, symptoms, or disorders
  ex. Trauma Symptom Inventory or Pain Patient Profile

Question 16

Omnibus measures

Answer 16

• comprehensive psychological test or questionnaire that covers several constructs (ie personality traits)
• attempt to cover a wide range of clinical
  psychopathology
• typically self-report
• contain clinical and validity measures
• Can directly assess clinical psychopathology or assess mental and
  personality clusters and infer psychopathology from that profile
  ex. Personality inventories

Question 17

Personality Assessment Inventory (PAI)

Answer 17

• 344-item self-report questionnaire
  that attempts to understand an individual’s personality traits and characteristics
• Provides clinical and validity scales
• has diagnostic considerations based on DSM-IV
• has Axis 1 (mental health and substance use disorders) and Axis 2 (personality disorders and mental retardation)

Question 18

Minnesota Multiphasic Personality Inventory (MMPI)

Answer 18

• serves to detect personality & psychopathology
  (multiphasic)
• has both clinical scales and validity indicators

Question 19

Evidence-based assessment

Answer 19

selection of assessment measures based on research evidence attesting to the reliability and validity of the measures and reading level required

Question 20

Computerized Axial Tomography (CT scan)

Answer 20

• Used for structural abnormalities
• computer uses info from x-ray scans to construct 2D image of different cross sections
• can show things such as calcification, bleeds, bone abnormality, or ventricle enlargement

Question 21

Magnetic Resonance Imaging (MRI)

Answer 21

• produces higher quality pictures than CT scan
• does not use radiation
• placed inside magnet, causes movement of hydrogen atoms that gives off resonance that can be translated into pictures of brain tissue
• can show things such as lesions, atrophy, and shearing/tearing

Question 22

Functional Magnetic Resonance Imaging (fMRI)

Answer 22

• Provides a picture of brain function, rather than structure
• measures change in blood flow
• see the brain ‘at work’ - cognition, emotion, experiences

Question 23

Positron Emission Tomography

Answer 23

• uses a radioactive tracer
• detects blood flow with the tracer to see function
• detects activation
• creates a 3D image

Question 24

Limitations of Neuroimaging (biological assessment)

Answer 24

1. Lack of diagnostic specificity
   - Many disorders show overlapping brain activity patterns
   - brain scan cannot diagnose mental illness reliably
2. Expensive and limited accessibility
3. Ecological validity is low
   - Neuroimaging often occurs in unnatural, controlled environments which may not reflect real-world psychological functioning

Question 25

Neuropsychological Assessment

Answer 25

- comprehensive assessment of cognitive and behavioural functions using a set of standardized tests and procedure - recommended for any case in which brain-based impairment in cognitive function or behaviour is suspected ex. Intelligence Testing

Question 26

Wechsler Adult Intelligence Scale-IV (WAIS-IV)

Answer 26

- neuropsychological tests - Originally developed to help new recruits to be evaluated and placed in “appropriate” jobs - 4 subscale measure consisting of Verbal and Performance subtests that yield Full-Scale, Verbal, and Performance Scores and four additional indices

Question 27

Wechsler Abbreviated Scale of Intelligence II (WASI-II)

Answer 27

- abbreviated version that takes approximately 15 – 30 minutes to administer, and can provide Full scale, Verbal, and Performance IQ scores - Correlates 0.84 – 0.92 with the WAIS-IV

Question 28

Wechsler Adult Intelligence Scale (WAIS) Indices

Answer 28

- breaks intelligence down into four major Index scores 1. Verbal Comprehension Index (VCI) - measure of verbal reasoning, comprehension, expressive language 2. Perceptual Reasoning Index (VCI) - measure of visual processing and reasoning 3. Working Memory Index (VCI) - measure of attention and concentration, auditory processing, and manipulation of information 4. Processing Speed Index (VCI)

Question 29

Limitations of Neuropsychological Evaluation

Answer 29

- lack ecological validity cause tests are administered in controlled environment - Domains of cognitive functioning identified by neuropsychologists are numerous - neuropsychology reduces complex behaviours to component cognitive domains

Question 30

Malingering

Answer 30

- deliberate feigning or exaggeration to portray deficit in order to gain something - assessed with Symptom Validity Measures (SVTs) and Performance Validity Measures (PVTs)