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Chapter 3 Clinical Assessment and Diagnosis. Assessing Psychological Disorders. Purposes of Clinical Assessment To understand the individual To predict behavior To plan treatment To evaluate treatment outcome Analogous to a Funnel Starts broad Multidimensional in approach

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assessing psychological disorders
Assessing Psychological Disorders
  • Purposes of Clinical Assessment
    • To understand the individual
    • To predict behavior
    • To plan treatment
    • To evaluate treatment outcome
  • Analogous to a Funnel
    • Starts broad
    • Multidimensional in approach
    • Narrow to specific problem areas
three concepts determine the value of assessment
Three Concepts Determine the Value of Assessment
  • Reliability
    • Examples include test-retest, inter-rater reliability
  • Validity
    • Examples include content, concurrent, discriminant, construct, and face validity
  • Standardization and Norms
    • Examples include administration procedures, scoring, and evaluation of data
domains of assessment the clinical interview and physical exam
Domains of Assessment:The Clinical Interview and Physical Exam
  • Physical Exam – Referral to physician
    • Rule out medical conditions
  • Clinical Interview
    • Most common clinical assessment method
    • Structured or semi-structured
  • Mental Status Exam
    • Appearance and behavior
    • Thought processes
    • Mood and affect
    • Intellectual functioning
    • Sensorium
domains of assessment behavioral assessment and observation
Domains of Assessment:Behavioral Assessment and Observation
  • Behavioral Assessment
    • Focus on here and now
    • Tends to be direct and minimally inferential
    • Target behaviors are identified and observed
    • Focus on antecedents, behaviors, and consequences
  • Behavioral Observation and Behavioral Assessment
    • Can be either formal or informal
    • Self-monitoring vs. others observing
    • Problem of reactivity using direct observation
domains of assessment psychological testing and projective tests
Domains of Assessment:Psychological Testing and Projective Tests
  • Psychological Testing
    • Must be reliable and valid
  • Projective Tests
    • Project aspects of personality onto ambiguous stimuli
    • Roots in psychoanalytic tradition
    • High degree of inference in scoring and interpretation
    • Examples include the Rorschach Inkblot Test, Thematic Apperception Test
    • Reliability and validity data tend to be mixed
domains of assessment psychological testing and objective tests
Domains of Assessment: PsychologicalTesting and Objective Tests
  • Objective Tests
    • Test stimuli are minimally ambiguous
    • Roots in empirical tradition
    • Require minimal inference in scoring and interpretation
  • Objective Personality Tests
    • Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-A)
    • Millon Clinical Multiaxial Inventory
  • Objective Intelligence Tests
    • WAIS/WISC – Performance and Verbal Scales
    • Stanford-Binet – Mental Age/Age = IQ
    • Raven Progressive Matrices Test – Non-verbal
domains of assessment psychological testing and neuropsychology
Domains of Assessment: PsychologicalTesting and Neuropsychology
  • Neuropsychological Tests
    • Assess broad range of skills and abilities
    • Goal is to understand brain-behavior relations
    • Used to evaluate a person’s assets and deficits
    • Examples include the Luria-Nebraska and Halstead-Reitan Batteries
    • Overlap with intelligence tests
domains of assessment neuroimaging and brain structure
Domains of Assessment:Neuroimaging and Brain Structure
  • Neuroimaging: Pictures of the Brain
    • Allows examination of brain structure and function
  • Imaging Brain Structure
    • Computerized axial tomography (CAT or CT scan)
      • CAT utilizes X-rays of brain; pictures in slices
    • Magnetic resonance imaging (MRI)
      • MRI has better resolution than CAT scan
      • MRI operates via strong magnetic field around head
domains of assessment neuroimaging and brain function cont
Domains of Assessment:Neuroimaging and Brain Function (cont.)
  • Imaging Brain Function
    • Positron emission tomography (PET)
    • Single photon emission computed tomography (SPECT)
      • Both involve injection of radioactive isotopes
      • React with oxygen, blood, and glucose in the brain
    • Functional MRI (fMRI) – Brief changes in brain activity
      • Used mainly in research
diagnosing psychological disorders foundations in classification
Diagnosing Psychological Disorders:Foundations in Classification
  • Clinical Assessment vs. Psychiatric Diagnosis
    • Assessment – Idiographic approach
    • Diagnosis – Nomothetic approach
    • Both are important in treatment planning and intervention
  • Diagnostic Classification
    • Classification is central to all sciences
    • Develop categories based on shared attributes
  • Terminology of Classification Systems
    • Taxonomy – Classification in a scientific context
    • Nosology – Taxonomy in psychological / medical contexts
    • Nomenclature – Nosological labels (e.g., panic disorder)
diagnosing and classifying psychological disorders
Diagnosing and Classifying Psychological Disorders
  • The Nature and Forms of Classification Systems
    • Classical (or pure) categorical approach – Categories
    • Dimensional approach – Classification along dimensions
    • Prototypical approach – Both classical and dimensional
  • Two Widely Used Classification Systems
    • International Classification of Diseases and Health Related Problems (ICD-10); published by the World Health Organization
    • Diagnostic and Statistical Manual of Mental Disorders (DSM); published by the American Psychiatric Association; currently the DSM-IV and DSM-IV-TR
purposes and evolution of the dsm
Purposes and Evolution of the DSM
  • Purposes of the DSM System
    • Aid communication
    • Evaluate prognosis and need for treatment
    • Treatment planning
  • DSM-I (1952) and DSM-II (1968)
    • Both relied on unproven theories and were unreliable
  • DSM-III (1980) and DSM-III-R
    • Were atheoretical, emphasizing clinical description
    • Multiaxial system with detailed criterion sets for disorders
    • Problems included low reliability, and reliance on committee consensus
the dsm iv
  • Basic Characteristics
    • Five axes describing full clinical presentation
    • Clear inclusion and exclusion criteria for disorders
    • Disorders are categorized under broad headings
    • Empircally grounded prototypic approach to classification
  • The Five DSM-IV Axes
    • Axis I – Most major disorders
    • Axis II – Stable, enduring problems (e.g., personality disorders, mental retardation)
    • Axis III – Medical conditions related to abnormal behavior
    • Axis IV – Psychosocial problems
    • Axis V – Global clinician rating of adaptive functioning
  • Other Unique Features of the DSM-IV
unresolved issues in the dsm iv
Unresolved Issues in the DSM-IV
  • What Are the Optimal Thresholds for Diagnosis?
    • Examples include level or distress, impairment, number of required symptoms
  • Arbitrary Time Periods in the Definitions of Diagnoses
  • Should Other Axes Be Included?
    • Examples include premorbid history, treatment response, family functioning
  • Is the DSM-IV System Optimal for Treatment or Research?
    • The Problem of Comorbidity
    • Defined as two or more disorders for the same person
    • High comorbidity is the rule clinically
    • Comorbidity threatens the validity of separate diagnoses
summary of clinical assessment and diagnosis
Summary of Clinical Assessment and Diagnosis
  • Clinical Assessment and Diagnosis
    • To provide a complete picture of the client
    • To aid understanding and ameliorating human suffering
    • Require reliable, valid, and standardized information
  • Dangers of Diagnosis
    • Problem of reification
    • Problem of stigmatization
  • Assessment and Diagnosis
    • The core of abnormal psychology
    • Requires a multidimensional perspective