Clinical Assessments: methods and purpose Flashcards
(33 cards)
What are the methods of clinical assessment?
- Clinical interview
- Personality Assessments
- Questionnaires
- Corroborative reports
- Self-report
- Self-monitoring forms
- Observation
- Measuring Process and Outcome of therapy
What is the purpose of a clinical interview?
- Mental Status Examination
- Diagnosis
- Risk assessment (suicidal?)
- Formulation
- Understand client’s goals for assessment or therapy
- Understand process issues that might guide the course of therapy
What are the 3 phases of a clinical interview?
- Opening
- warm up and rapport building
- assess the suffering, empathies
- Middle
- history, mental status, assessment, determine client’s level of insight
- End
- summaries conclusions
- focus on goals and hope for future
What are the areas covered by a clinical interview?
• Ask about presenting problem (what brings them in today)
• Explore current psychological functioning and symptom formation (identify diagnoses and differential diagnoses)
• Mental Status Examination throughout interview
• Risk assessment
Personal history
• Current social systems
• Strengths, competencies and abilities
What is included in a Mental Status Examination?
observation of the clients: ○ Appearance ○ Behaviour ○ Thought Form ○ Thought Content ○ Perception ○ Affect\Mood ○ Orientation ○ Judgement ○ Insight ○ Intelligence
What is included in the observation of thought?
- Rate, responsivity and spontaneity
- Coherence – use of standard grammatical forms and sentence structure
- Capacity to sustain train of thought
- Circumstantiality
- Tangentiality
- Flight of ideas
- Thought block
- Word salad
- Unusual word usage – neologisms
What is included in Perception observation?
- Sensory distortions and illusions
- Hallucinations:
- hearing
- vision (implications)
- smell, taste and touch
- Depersonalisation and derealisation (the world isn’t real they are in a movie)
What is included in Cognition observation?
- Orientation to time, place and person
- Attention and concentration: distraction due to intrusive thoughts, impaired reasoning, impaired concentration
- Memory
- Capacity for abstraction and reasoning
What are the risk factors in a Suicide Risk Assessment?
- Ideation, Plans, Intent to act, Means,
- Acute stress (especially interpersonal)
- Depression
- Impulse control problems
- Humiliation/embarrassment
- Hopelessness
- Use of substances
- Previous models of self-harm
What are the protective factors in a Suicide Risk Assessment?
- Beliefs (e.g. moral or religious)
- Family (e.g. children)
- Social Support
- Upcoming positive experiences to look forward to
What is the purpose of diagnosis?
- Description of levels of psychopathology
- Communication between health professionals
- Guide Treatment
- Inform prognosis
- Guides Research
- Identifying the capacity of someone to stand trial
- Cognitive or functional impairment
- Help client
What is included in diagnostic reasoning?
Cues -> inferences -> pattern -> hypotheses -> Inquiry (evidence as well) -> conclusion -> formulation
What is a mental disorder?
A significant behaviour that occurs in an individual that is associated with distress or disability, or an increased risk for suffering death, pain, disability, or an important loss of freedom. This syndrome must not be due to a culturally sanctioned response.
What is a categorical system e.g. DSM?
- Presence/absence of a disorder: either you are anxious or you are not anxious.
What is a dimensional system?
- Rank on a continuous quantitative dimension: how anxious are you on a scale of 1 to 10?
What are the advantages of categorical and dimensional systems?
Dimensional systems may better capture an individual’s functioning but the categorical approach has advantages for research and understanding
Describe the DSM I
○ 1952
○ Myers psychobiological view
○ Disorders cause by personality “REACTION”
Describe the DSM II
○ 1968
○ Basically the same but references to “reaction” were removed
Describe the DSM III
○ Published in 1980
○ Free from theories of etiology
○ Initiates use of Multi-axis system
Describe the DSM III-R
○ 1987 Revisions made to clarify diagnoses
Describe the DSM IV
○ Published 1994
○ Categorical
○ Cultural and ethnic considerations
○ Not based on deviant behaviors
Describe the DSM V
○ Published 2013
○ changes in diagnostic criteria (e.g. removal of criteria e.g. bereavement is no longer an exclusion criteria for depression)
What is in the DSM-5?
Describes criteria for diagnoses, key clinical features, and related features that are often, but not always, present
The Major depressive disorder criteria requires Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either…
(1) depressed mood: most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
or (2) loss of interest or pleasure: in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
