Clinical Assessment, Diagnosis, and Treatment PDF

Assessment, Diagnosis, and Treatment RYAN MAREK, PH.D. S AM HOUSTON STATE UNIVERSITY Purpose of Assessment Goals of Clinical Assessment Gather data about a person and his/her environment in order to make decisions about the nature, status, or treatment of psychological problems 1. Screening 2. Di...

Assessment, Diagnosis, and Treatment RYAN MAREK, PH.D. S AM HOUSTON STATE UNIVERSITY Purpose of Assessment Goals of Clinical Assessment Gather data about a person and his/her environment in order to make decisions about the nature, status, or treatment of psychological problems 1. Screening 2. Diagnosis and treatment planning 3. Outcome evaluation Screening o Given to all o We want these to be sensitive (i.e., to have a low threshold) o Brief o NOT ENOUGH TO DIAGNOSE o Because they have a low threshold by design, more specific follow-up is needed for diagnosis Diagnosis and Treatment Planning Differential diagnosis Why diagnose? ◦ Facilitates communication w/ clinicians and researchers ◦ Appropriate treatment planning ◦ Insurance reimbursement  Outcome Evaluation Did my treatment work? Is my treatment working? “Measurement-based Care” ◦ Adjust treatment length and focus ◦ Give feedback on progress to patients ◦ Determine when clinically significant change has occurred Properties of Psychological Tests Psychometric Properties Standardization: Tests administered the same to everyone Putting score in context ◦ Test scores based on a representative group of individuals ◦ Normative comparisons Psychometric Properties: Can we trust the test? Reliability: Are scores consistent? ◦ Test-retest ◦ Interrater agreement Validity: Measuring what you think you’re measuring? ◦ Construct validity ◦ Criterion validity (SAT & ACT) ◦ Predictive validity (SAT  GRE) ◦ Clinical prediction not as good as statistical prediction! (136 Studies!) Types of Testing Clinical Interviews oUnstructured oStructured Psychopathology Tests Objective personality tests o Measuring symptoms of psychopathology using sets of scales (e.g., Anxiety, Depression, Psychosis, etc.) o Minnesota Multiphasic Personality Inventory-3 (MMPI-3) o 335 True/False items o Personality Assessment Inventory (PAI) o 367 items on a 1-4 scale Personality Tests Projective personality tests ◦ Rorschach ◦ Identify figures in various ambiguous inkblots ◦ Thematic Apperception Test ◦ Make up a story based on an ambiguous drawing Symptom Measures Measures of general psychological functioning ◦ Example: General Health Questionnaire Measures of specific symptoms ◦ Example: Beck Depression Inventory–II ◦ Beck Anxiety Inventory Cognitive Testing o Intelligence Testing o Produce an intelligence quotient (IQ) based on person’s mental age compared to his or her age-matched peers o Used in a variety of contexts (e.g., educational assessment, dementia) o Neuropsychological Testing o Assesses a variety of cognitive abilities o Memory, executive functioning, attention, visuospacial functioning Behavioral Assessment Self-monitoring: patient observes and records his or her own behavior as it happens ◦ Activity log, smoking log, etc. Functional analysis: identify causal links between problem behaviors and contextual factors ◦ Antecedents  Behaviors  Consequences Diagnosis Classification of Abnormal Behaviors Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA) Diagnostic Problems Comorbidity: the presence of more than one disorder ◦ Half of people w/1 disorder have 2 disorders! ◦ Is this 2 distinct disorders or manifestations of 1 disorder? o Diagnostic cut-offs aren’t based on empirical studies o Not all people with same diagnosis have the same symptoms, and symptoms may have different roots Dimensional Systems as an Alternative? o Symptoms of disorders are simply extreme variations of normal experience o Patient’s functioning rated on several dimensions o Ex: disinhibition, neuroticism, social detachment o Benefits of dimensional approach o VERY strong empirical support o Richer description of patient difficulties across multiple areas of dysfunction o Better understanding of a patient whose symptoms do not fit into any existing category The field is moving in this direction!! Psychological Treatment Making Treatment Decisions Begin with assessment information and diagnostic decisions to determine a treatment plan Other factors ◦ Therapist's theoretical orientation ◦ Current research ◦ General state of clinical knowledge: Currently focuses on empirically supported, evidence-based treatment Which factors contribute to therapy outcomes? Evaluating Treatment Options Is therapy in general effective? ◦ People in therapy are usually better off than people with similar problems who receive no treatment. Are particular therapies generally effective? ◦ Various therapies do not appear to differ dramatically in their general effectiveness. Are particular therapies effective for particular problems? ◦ Certain therapies or combinations of therapies do appear to be more effective than others for certain disorders.