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?

Discussion of the presenting problem and the client’s history

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 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 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

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

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 problems may mimic psychological disorders

Thyroid issues

Brain lesions/tumors

Dementia

Drug induced conditions

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

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

Projective Tests

Personality Inventories

Intelligence Tests

Neuropsychological 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

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

MMPI

Sample Questions: I often think I’m being followed I am often happy for no reasonSometimes I get so mad I want to swear I sometimes throw up after mealsEvil 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

Results in a “code type”

Looking at answers left blank

Excellent reliability, good validity

Neuropsychological Tests

NeuroimagingCAT 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

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

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

Five “Axes” or Dimensions

Axis I: The DisorderAxis 2: Personality Disorder/MRAxis 3: Medical ConditionsAxis 4: Problems: Psychosocial &

EnvironmentalAxis 5: Global Assessment of Functioning

(Scale)

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

In progress

Various workgroups: clinicians and researchers

Revisions/new additions