- CLINICAL INTERVIEW - SYMPTOM QUESTIONNAIRES - BEHAVIORAL OBSERVATIONS AND SELF MONITORING - PERSONALITY INVENTORIES - INTELLIGENCE TESTS - NEUROPSYCHOLOGICAL TESTS - BRAIN IMAGING TECHNIQUES - PSYCHOPHYSIOLOGICAL TESTS & PHYSICAL -EXAMINATION - PROJECTIVE TESTS

Clinical Assessment and Diagnosis Flashcards by CHOWLIFO CHINGLAYO

Gathering information regarding people’s symptoms and the possible causes of these symptoms

ASSESSMENT

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• A label for a set of symptoms that often occur together
• process of determining whether the particular problem afflicting the individual meets all criteria for a
psychological disorder

DIAGNOSIS

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the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

CLINICAL ASSESSMENT

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– Tools have been developed by clinicians to gather

information

Assessment Tools

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•Accuracy of a test to measure what it is designed to measure

Validity

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Based from face value, it can measure what it purports

to measure

FACE VALIDITY

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Extent to which a test assesses all the important aspects of a phenomenon that it purports to measure

CONTENT VALIDITY

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extent to which a test yields the same results as other,
established measures of the same behavior, thoughts,
or feelings (standard but long vs. brief, new)

CONCURRENT VALIDITY

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•good at predicting how a person will think, act, or feel

in the future (IQ—success in school)

PREDICTIVE VALIDITY

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•extent to which a test measures what it is supposed to

measure and not something else altogether

CONSTURCT VALIDITY

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•Consistency of a test in measuring what it is supposed to measure

Reliability

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Consistency of the test results over

time

TEST RETEST RELIABILITY

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• Results on a similar version of the test are similar

ALTERNATE FORM RELIABILITY

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Similarity in people’s answers
among different parts of the same
test

INTERNAL RELIABILITY

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Interjudge Reliability

INTER RATER RELIABILITY

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•A way to improve validity and reliability

Standardization

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ASSESSMENT TOOLS

CLINICAL INTERVIEW
SYMPTOM QUESTIONNAIRES
BEHAVIORAL OBSERVATIONS AND SELF MONITORING
PERSONALITY INVENTORIES
INTELLIGENCE TESTS
NEUROPSYCHOLOGICAL TESTS
BRAIN IMAGING TECHNIQUES
PSYCHOPHYSIOLOGICAL TESTS & PHYSICAL -EXAMINATION
PROJECTIVE TESTS

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Much of the information is gathered through an initial interview

CLINICAL INTERVIEW

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Person’s general functioning

MENTAL STATUS EXAM
--Appearance and Behavior
– Thought Processes
• Speech
– Mood and Affect
– Intellectual Functioning
• Memory and Attention
– Orientation/Sensorium
• Time, place, person, object

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– Series of questions asked about a particular symptom that is currently experienced or experienced in the past
– format of the questions and the entire interview is standardized, and the clinician uses concrete criteria to score the person’s answers

Structured Interviews

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made up of questions phrased and tested to elicit useful information

SEMI STRUCTURED INTERVIEW

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– have no systematic format
• “Tell me about yourself”
• Start from what is significant to the clinician

Unstructured Interviews

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-Pays attention to the medical condition of the client which might cause the psychological problem
-Assessing If a medical condition or substance
abuse is merely coexisting or a casual one
• Rule out or manage conditions which are
exacerbating the condition of the client
– Eg. Hypothyroidism, brain tumor, panic attacks

PHYSICAL EXAMINATION
By Physician
– Neurodev
– Neurologist
– Psychiatrist

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REMEMBER

Questionnaires can cover a wide variety of

symptoms representing several different disorders

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Used for individuals who are not old enough or skilled enough to report their problems and experiences – Individuals with special needs – Individuals who are physically and psychologically challenged – Elders – Young children

BEHAVIORAL ASSESSMENT

– to assess deficits in skills or ways of handling situations – looking for specific behaviors and what precedes and follows these behaviors

Behavioral Observation Advantage: not relying on self-reports – Disadvantage: changing of behavior when observed; different conclusions/observer

– relies on observer’s recollection | and interpretation of events

Informal

– involves identifying specific behaviors that are observable or measurable, having an operational definition

Formal

ABCs of Observation

– Antecedents – Behavior – Consequences

– Keeping track of behaviors

Self-Monitoring – Disadvantage: bias of the individual to report behaviors – Advantage: discovery of triggers of certain behaviors

- Questionnaires meant to assess people’s typical ways of thinking,feeling, and behaving - Part of an assessment procedure to obtain information on people’s wellbeing, self-concept, attitudes and beliefs, ways of coping, perceptions of their environment and social resources, and vulnerabilities

PERSONALITY INVENTORIES MMPI – Minnesota Multiphasic Personality Inventory – MMPI-2: 567 items

In clinical practice,_____ are used to get a sense of an individual’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected

``` intelligence tests . Wechsler Adult Intelligence Scale , the Stanford-Binet Intelligence Test , and the Wechsler Intelligence Scale for Children ```

Useful in detecting specific cognitive deficits such as a memory problem • Used when impairment in neurological functioning is suspected

NEUROPSYCHOLOGICAL TEST Paper-and-pencil – Bender-Gestalt Test (Bender Visual Motor Gestalt Test, BVMGT), Strength of Grip Test

When people attempt to understand an ambiguous or vague stimulus, their interpretation of the stimulus reflects their needs, feelings, experiences, prior conditioning, thought processes and so forth

PROJECTIVE HYPOTHESIS

People are thought to project these issues onto their description of the “content” of the stimulus • Useful in uncovering the unconscious issues or motives of a person or in cases when the person is resistant or heavily biasing the information he or she presents to the assessor

PROJECTIVE TEST – Rorschach Inkblot Test, Thematic Apperception Test, Sentence Completion Tests, HTP, DAPT

CHALLENGES IN ASSESSMENT

``` Resistance – Does not want to provide information • Inability to Provide Information • Assessing Children • Assessing Individuals Across Cultures ```

It is the tendency for people to accept very general or vague characterizations of themselves and take them to be accurate

BARNUM EFFECT

To identify specific deficits and possible brain abnormalities • To determine if there is brain injury, tumors, or damage • Brain Activity and Structure

BRAIN IMAGING

BRAIN IMAGING TECHNIQUES

-COMPUTERIZED TOMOGRAPHY (CT) Enhanced x-ray procedure • Brain structure -POSITRON EMISSION TOMOGRAPHY Brain activity • Requires injecting the patient with a harmless radioactive isotope, such as fluorodeoxyglucose -SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) Similar to PET but different tracer substance, lesser accuracy, cheaper -MAGNETIC RESONANCE IMAGING • Detailed structure of brain anatomy • fMRI - functions

alternative methods to CT, PET, SPECT, and MRI used to detect changes in the brain and nervous system that reflect emotional and psychological changes

PSYCHOPHYSIOLOGICAL TEST

– electrical activity along the scalp produced by the firing of specific neurons in the brain

Electroencephalogram (EEG)

•Label that is attached to a set of symptoms that occur together

DIAGNOSIS

SET OF SYMPTOMS

SYNDROME

PROCESS OF DIAGNOSIS

Symptomatic Diagnosis • Aimed to remove the symptoms Characterological Diagnosis • Aimed at identifying the personality dynamics – character

Look into the typical signs and symptoms manifested by the individual – With the symptoms, one can identify the disorder

SYMPTOMATIC DIAGNOSIS

Look into the personality dynamics, personality, psychodynamics, or behavior dynamics – Needs, motives – satisfied or unsatisfied – Conflicts • Unresolved conflicts – Fixations – Coping mechanisms • Defense mechanisms

Characterological Diagnosis

- Full evaluation of the patient’s personality structure and functioning - Give emphasis on the specific behavior patterns of the patient

PSYCHODIAGNOSIS

Specific Behavior patterns may be:

ADAPTIVE – can beutilized in the treatment MALADAPTIVE – maylead to mental disorders

PSYCHODIAGNOSIS

``` Classify the disorder of the patient Do differential diagnosis Psychodiagnostic impression can change Consider other factors such as duration ```

DIAGNOSIS APPROACH

Idiographic Approach • Specific to the patient Nomothetic Approach • Universal or global

GOALS OF DIAGNOSIS

- Aimed at treatment rather than classification - Prognosis - Development of Insight

2 PHASE OF DIAGNOSIS

1. DESCRIPTIVE PHASE • Give a battery of psychological tests • Interview • Organogenic vs. Psychogenic ``` 2. INFERENTIAL PHASE • Interpretative Phase • Makinginferences • Making interpretations • Formulating theories ```

•referring simply to any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations—a nomothetic strategy.

CLASSIFICATION

•which is the classification of entities for scientific purposes

Taxonomy

•applying a taxonomic system to psychological or medical phenomena or other clinical areas

Nosology

describes the names or labels of the disorders that make up the nosology

Nomenclature

Classical Categorical Approach

* Categories | * Criteria

• note the variety of cognitions, moods, and behaviors with which the patient presents and quantify them on a scale • Personality Disorders (Axis II)

Dimensional Approach

• identifies certain essential • characteristics of an entity so that it can be classified, but it also allows certain nonessential variations that do not necessarily change the classification

Prototypical Approach

Official Manual for Diagnosing Psychological | Disorders

``` American Psychiatric Association • DSM : 1952 • DSM-II: 1968 • DSM-III: 1980 • DSM-IIIR: 1987 • DSM-IV: 1994 • DSM-IV-TR: 2000 • DSM-V: 2013 ```

``` – 5 axes or dimensions used to evaluate an individual – First two are actual diagnosis of disorders; the 3 are criteria required for such diagnosis ```

Uses a Multi-axial | System

THE AXIS OF DSM IV

``` Axis I Clinical Attention • Personality Disorders & Mental Axis II Retardation Axis III • General Medical Conditions • Psychosocial and Environmental Axis IV Problems Axis V • Global Assessment of Functioning ```

REMEMBER

1. A REVIEW AND VISIT OF THE DSM IV-TR FORMAT AND ITS DIFFERENT AXIS 2. IT’S USE ON HOW TO IDENTIFY PATHOLOGY

– condition established after study to be chiefly responsible for occasioning the admission of the individual

*Principal Diagnosis

– when more than one diagnosis is given for an individual in an outpatient setting, this is the condition that is chiefly responsible for the ambulatory care medical services received during the visit

Reason for visit

REMEMBER

If no Axis I disorder is present, this should be coded as V71.09 • If an Axis I diagnosis is deferred, pending the gathering of additional information, this should be coded as 799.9

DANGERS IN DIAGNOSIS

1. The person labeled as abnormal is treated differently by society and this treatment can continue long after the person stops exhibiting the behaviors labeled normal. 2. Another danger in labeling people is the idea of stimatization.

AVOIDING DANGERS OF DIAGNOSIS

• DIAGNOSIS is important, however, clinicians and researchers need to communicate regarding definitions of disorders. • When a system of definitions of disorder is agreed on, then can communication about disorders be improved.

Clinical Assessment and Diagnosis Flashcards

(68 cards)