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Clinical Assessment and Diagnosis. Chapter 3 Abnormal Psychology. Clinical Assessment. Protocols used for evaluation and measurement Assessing/diagnosing psychological disorders. Getting Started. What brings the client to the provider?

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clinical assessment and diagnosis

Clinical Assessment and Diagnosis

Chapter 3

Abnormal Psychology

clinical assessment
Clinical Assessment
  • Protocols used for evaluation and measurement
  • Assessing/diagnosing psychological disorders
getting started
Getting Started
  • What brings the client to the provider?
  • Discussion of the presenting problem and the client’s history
concepts in assessment
Concepts in Assessment
  • Reliability: the consistency of measurement
  • Validity: does it measure what it is meant to measure?
  • Standardization: comparing individuals with similar persons; asking questions in a consistent manner
the clinical interview
Current and past behavior

Emotions and attitudes

A detailed history

The presenting problem

Significant life events

Childhood information and family history

Sexual development

Religious beliefs/cultural background

Educational history

The Clinical Interview
the mental status exam
The Mental Status Exam
  • 1. Appearance and Behavior-motor behavior, movements
  • 2. Thought process-rate/flow of speech; coherence; any evidence of delusions/hallucinations?
  • 3. Mood and Affect-what is the mood and is it consistent? What is affect like and is it appropriate?
the mental status exam7
The Mental Status Exam
  • Intellectual functioning:vocabulary, use of language; general sense of cognitive abilities
  • Sensorium:Awareness of immediate surroundings; Oriented x3? (Person, place, time)
issues to consider
Issues to Consider
  • Is the client presenting the central issues? Are there other issues the client sees as unimportant?
  • Establishing rapport
  • Confidentiality: Scope and limitations
other clinical interviews
Other Clinical Interviews
  • Interviews or instruments specific to a particular disorder or concern: to learn the specific symptoms and their severity
    • Anxiety Disorders Interview Schedule- questions specific to compulsions and obsessions
    • Eating Disorder interviews/scales
physical exam
Physical Exam
  • Physical problems may mimic psychological disorders
    • Thyroid issues
    • Brain lesions/tumors
    • Dementia
    • Drug induced conditions
behavioral assessments
Behavioral Assessments
  • Observing the client in specific contexts, in real life settings or simulated situations
  • Asking others to fill out behavior “checklists”
    • Often used with children: school and home visits
self monitoring
Self-Monitoring
  • Clients may be asked to keep a log of their thoughts/behaviors
  • When the behaviors occur in private
    • To note frequency, severity, and “triggers”; for self-reflection
overview of psychological tests
Overview of Psychological Tests
  • Projective Tests
  • Personality Inventories
  • Intelligence Tests
  • Neuropsychological Tests
projective tests
Projective Tests
  • Client “projects” thoughts and feelings- to reveal unconscious thoughts
  • Rorschach (ink blot test)
  • Thematic Apperception Test (TAT)
    • Critique: limited reliability/validity; not directly linked to the process of diagnosis
personality inventories
Personality Inventories
  • Comparing an individual’s score with the pattern of responses of those with diagnosed psychological conditions
  • MMPI: Minnesota Multiphasic Personality Inventory
  • 567 true/false questions
slide16
MMPI
  • Sample Questions:
    • I often think I’m being followed
    • I am often happy for no reason
    • Sometimes I get so mad I want to swear
    • I sometimes throw up after meals
    • Evil spirits possess me at times
mmpi scales
Clinical Scales:

1: Hypochondriasis

2: Depression

3: Hysteria (Conversion)

4: Psychopathic Deviant

5: Masculinity/Femininity

6: Paranoia

7: Psychastenia (Anxiety)

8: Schizophrenia

9: Hypomania

0: Social Introversion

Lie Scale;

Infrequency Scale (to detect random answers);

Defensiveness Scale

MMPI: Scales
slide18
MMPI
  • Results in a “code type”
  • Looking at answers left blank
  • Excellent reliability, good validity
neuropsychological tests
Neuropsychological Tests
  • Neuroimaging
    • CAT scans/MRI: to assess brain damage and to look at the structures of the brain
    • PET scans: the functioning/activity of the brain
    • EEG: brain waves
issues in diagnosis
Issues in Diagnosis
  • Diagnostic and Statistical Manual
  • Reliability/Validity
    • Some diagnoses have greater reliability/validity than others
      • Personality Disorders tend to have lower reliability
diagnostic and statistical manual
Diagnostic and Statistical Manual
  • I and II were not widely used; lacked precision, were unscientific, and had little reliability
  • DSM III: 1980: more atheoretical; more precise descriptions; reliability/validity studies
axes 1 5
Axes 1-5
  • Five “Axes” or Dimensions
    • Axis I: The Disorder
    • Axis 2: Personality Disorder/MR
    • Axis 3: Medical Conditions
    • Axis 4: Problems: Psychosocial & Environmental
    • Axis 5: Global Assessment of Functioning (Scale)
critique of the dsm
Critique of the DSM
  • Culturally sensitive?
  • Stigma of labels
  • “Fuzzy” categories and co-morbidity
  • Categories based more on history than current science? (Kraeplin’s dichotomy)
dsm v
DSM-V
  • In progress
  • Various workgroups: clinicians and researchers
  • Revisions/new additions