Chapter 3 - Clinical Assessment & Diagnosis Flashcards
(22 cards)
What is a clinical assessment
Systematic evaluation and measurement of psychological, biological, and social factors.
What is a diagnosis and what do we use to determine if someone has a diagnosis
Diagnosis: Perocess by which we come to understand if someone meets the criteria for a disorder.
Determined by: Diagnostic Statistical Manual for Mental Disorders (DSM – 5 – TR) (APA, 2022) in North America, there are other systems, ICD – 11, most widely used globally
what is reliability, validity (both types) , and standardization
- Reliability: Degree to which that assessment is consistent across measurements.
- Validity: Extent to which an assessment measures what it aims to measure.
o Concurrent validity: Both tests measure the thing it thinks its measuring.
o Predictive Validity: How well an assessment can measure what it claims to measure in the future. - Standardization: Develop norms and requirements of how to measure something.
what is a clinical interview
Clinical Interview: Assessment always begin with a presenting problem (something they want to work on) however the presenting problem may not be what we consider the underlying problem.
what are the types of clinical assessments.
- Physical Assessment: We shouldn’t assume things are all psychological
- Behavioural Assessment: Observing behaviour in a natural environment
what are the kinds of interviews
- Unstructured interviews: Open ended interview, not very planned but interested in information
o Can understand this through mental status exam: Don’t follow a set pattern - Semi structured interviews: Follow a pattern (rigid or semi rigid).
o Structured Interview for DSM-5 (SCID): Structured and helps to lead the interview to a particular categorization.
o Anxiety and related disorders Interview Schedule (ADIS-5):
o Can use these scales to lean on to try and understand if any, what the client may report to be feeling.
what is a mental status exam and what are the 5 components.
Mental Status Exam: Adopting curiosity of the human in front of us
1. Appearance and behaviour of the person: What they are wearing, how they move: Being curious about how these things may relate to their presenting problem or what they are experiencing.
2. General though processes of clients: Why people describe things the way they do and what they choose to say and share and how they do that.
3. General Mood & Affect: What underlying or general emotion do we lead with (e.g. passive).
4. General intellectual functioning: Thinking abstractly, logic centric, emotional in our language.
5. Sensorium: general awareness of space and time, where they are. Clients that fail to pay on time, always late, read their psychologists work.
what is self-monitoring
Self-Monitoring: All the ways in which we can encourage clients to observe and record their own behaviours.
what are two kinds of psychological testing that we discussed, explain how they work.
Projective Testing: Origins in psychoanalytic tradition (the unconscious, we have drives and impulses from our unconscious)
- Presenting clients with ambiguous stimuli and ask clients to quickly respond with what come to mind which will reveal themes or unconscious.
Thematic Apperception Test: Showing a photo and having participants provide a narrative through narrative fantasy that shows common themes of their unconscious.
what is the MMPI, how does it work, and what is criterion keying.
Minnesota Multiphasic Personality Inventory (MMPI): Has multiple validity measures.
- There are so many questions and there are similar questions that are worded differently with lie validity to pick up potential dishonesty
- Claims to be very reliable.
- Criterion Keying: We might think that many assessments are designed to arrive at a particular outcome, the MMPI works in reverse by:
o E.g. take a group of people who met criteria for Major Depressive disorder and have them take MMPI and compare the results against a control group. Move towards a personality type that is associated with major depression and if this generalizes and see if we can replicate it.
o We can analyze patterns and differences between two groups of people
what are the two kinds of neuroimaging techniques and explain them.
Brain Structure: Taking pictures of the brain to understand and analyze brain structures.
CAT Scan (CT): Non invasive, uses radiation and gets slices of the brain (Computed Tomography)
MRI: Magneti Resonance Imaging: Better than CT, radiofrequency and better resolution
what are the two kinds of neuro functioning techniques and how do they work.
Brain Function:
PET: Positron Emission Tomography. Inject with blood tracer and then view it as it moves through the body to measure brain activity
fMRI: Functional Magnetic Resonance Imaging: More immediate response to track brain function.
what do we know about fMRI about people with PTSD
o Learned we can categorize traumatic stress response in two ways:
1) Dissociative-type responses: less activity
2) Hyper-arousal type responses: More activity (Sympathetic Nervous System)
what is an eeg and what gap does it bridge
Electroencephalogram (EEG): Electric frequencies in the brain. Help diagnosing sleep related disorders.
- Emerging evidence and philosophical work that bridge the gap between things that may seem opposite (psychoanalysis and neurophysiology)
what is nosology
Nosology: Classifying and naming diagnoses/psychological phenomena
what are the approaches to nosology
Classical categorical approach: Has the following assumptions.
o Assumption that there are clear cut differences among disorders and that each disorder has a different cause. (single distinct phenomena with one cause and anxiety is separate and treated as such)
Becomes problematic because if someone has both, that means they are suffering from two causes and there is no relationship.
Dimensional approach: Different experiences (depression and anxiety) and they function on scales/dimension. Meaning everyone can have some level of these and at one point does that become a disorder.
o Theres no specific underlying distinct cause but that the human experience is founded on these dimensions and once we meet a threshold we can say there is a psychological disorder.
Prototypical approach: DSM functions on this approach that mixes both models. We use essential defining characteristics of a disorder while also acknowledging a range and variation of other characteristics.
What occurred pre 1980 regarding diagnosis
- Kraepelin’s Textbook of Psychiatry (1913): First documented thing of disorders. Wasn’t great but was important
o Came with up Dementia Praecox which is what we know is schizophrenia and he also outlined what we now know as bipolar disorder. - 1948: WHO adds mental illness section to ICD-6: A significant document trying to describe and categorize mental disorders.
- DSM-I, APA, 1952: No one read it
- DSM-II, APA, 1968: More people read it
- ICD – 8: Was modelled after DSM 2
what changes occured when they made the DSM 3 and DSM 3 - R
1) Atheoretical: Previous editions tried to explain diagnoses based on theories, but this one relied on descriptions (i.e. what symptoms can we experience from individuals with these disorders) making them more empirical. Increasing validity and reliability.
2) Casual Neutrality: No longer was it focussed on causes of disorders but what does it look like now.
3) Introduction of Multi-Axial Approach: Looking at different contributions outside of simply psychology that might contribute to this disorder. Emphasizes broader consideration of the whole person (social, medical etc factors)
what changes occured when they came out with the DSM 4 and DSM 4-TR
- Medical disorders related to psychological functions
- Personality disorders
- Global assessment of functioning
DSM-IV (1994): Collaboration with ICD
DSM-IV-TR (2000)
What changes occured when they came out with the DSM 5
discontinue multi-axial system (more efficiently laid out).
- Came up with dimensional assessments of the disorders
- Greater cultural emphasis to understand distinctions from different cultures or worldviews on how articular disorders are expressed and experienced.
What changes occured when they came out with the DSM 5 TR
- Included some new disorder (Prolonged grief disorder)
- Symptom codes for distinguishing between suicidal behaviour and non-suicidal self-injury
- Criteria refinement (made it harder)
what are 3 criticisms of the DSM
Stigma and Labelling: Is the creation of categorizing disorders more about the client or researchers and scientists to understand human behaviour
- Is the stigma, label and difficulty of the label more harmful than intended
- Labelling can increase stigma and the risk is seeing people as a protype opposed to a human being
- Individuals can have ow levels of severity of symptoms and not meet the criteria for the disorder (dimensions) and everyone might exhibit criteria at some point in their life.
Diagnosis as a conversation: Disorders shift and change over time. We create and destroy them politically. So, culture, society and politics play a role in where that conversation leads and who gets to decide.
- Comorbidity: People can experience multiple diagnoses at a time.
o How can we determine if diagnoses cause each other
Alternative views on diagnosis: Therapists should improve acceptance and greater tolerance for wide range of thoughts and affects because people who lack these capacities and people just want to feel better.
- Not about finding symptoms and reducing them but its an underlying assumption of what it means to be humans is to accept ourselves more and by accepting it we can then increase tolerance for emotions of human experience.
