3.-Clinical-Assessment-and-Diagnosis.pdf

Clinical Assessment and Diagnosis Clinical assessment Is the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. Diagnosis Is the process of determining whether the particular probl...

Clinical Assessment and Diagnosis Clinical assessment Is the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. Diagnosis Is the process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder. Key Concepts in Assessment Reliability Reliability is the degree to which a measurement is consistent. Imagine how irritated you would be if you had stomach pain and you went to four competent physicians and got four different diagnoses and four different treatments. Validity Is whether something measures what it is designed to measure, whether a technique assesses what it is supposed to. Standardization Is the process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measurements. The standards might apply to the procedures of testing, scoring, and evaluating data. Standardization For example, the assessment might be given to large numbers of people who differ on important factors such as age, race, gender, socioeconomic status, and diagnosis; their scores would be pooled with other individuals like them and then be used as a standard, or norm, for comparison purposes. For example, if you are an African American male, 19 years old, and from a middle-class background, your score on a psychological test should be compared with the scores of others like you and not to the scores of different people, such as a group of women of Asian descent in their 60s from working-class backgrounds. Reliability, validity, and standardization are important to all forms of psychological assessment. Clinical Interview The core of most clinical work, is used by psychologists, psychiatrists, and other mental health professionals. The interview gathers information on current and past behavior, attitudes, and emotions, as well as a detailed history of the individual’s life in general and of the presenting problem. Clinicians determine when the specific problem started and identify other events (for example, life stress, trauma, or physical illness) that might have occurred about the same time. In addition, most clinicians gather at least some information on the patient’s current and past interpersonal and social history, including family makeup (for example, marital status, number of children, or college student currently living with parents), and on the individual’s upbringing. Information on sexual development, religious attitudes (current and past), relevant cultural concerns (such as stress induced by discrimination), and educational history are also routinely collected. To organize information obtained during an interview, many clinicians use a mental status exam. Mental Status Exam Involves the systematic observation of an individual’s behavior. This type of observation occurs when any one person interacts with another. All of us, clinicians and nonclinicians alike, perform daily pseudo-mental status exams. The trick for clinicians is to organize their observations of other people in a way that gives them sufficient information to determine whether a psychological disorder might be present. Mental status exams can be structured and detailed, but mostly they are performed relatively quickly by experienced clinicians in the course of interviewing or observing a patient. The exam covers five categories: Mental Status Exam 1. Appearance and Behavior. The clinician notes any overt physical behaviors, as well as the individual’s dress, general appearance, posture, and facial expression. For example, slow and effortful motor behavior, sometimes referred to as psychomotor retardation, may indicate severe depression. Mental Status Exam 2. Thought Processes. When clinicians listen to a patient talk they’re getting a good idea of that person’s thought processes. They might look for several things here. For example, what is the rate or flow of speech? Does the person talk quickly or slowly? What about continuity of speech? In other words, does the patient make sense when talking, or are ideas presented with no apparent connection? In some patients with schizophrenia, a disorganized speech pattern, referred to as loose association or derailment, is quite noticeable. Mental Status Exam 2. Thought Processes. In addition to rate or flow and continuity of speech, what about the content? Is there any evidence of delusions (distorted views of reality)? Typical delusions would be delusions of persecution, in which someone thinks people are after him and out to get him all the time, or delusions of grandeur, in which an individual thinks she is all-powerful in some way. The individual might also have ideas of reference, in which everything everyone else does somehow relates back to the individual. The most common example would be thinking that a conversation between two strangers on the other side of the room must be about you. Hallucinations are things a person sees or hears when those things really aren’t there. For example, the clinician might say, “Let me ask you a couple of routine questions that we ask everybody. Do you ever see things or maybe hear things when you know there is nothing there?” Mental Status Exam 3. Mood and Affect. Determining mood and affect is an important part of the mental status exam. Mood is the predominant feeling state of the individual. Does the person appear to be down in the dumps or continually elated? Does the individual talk in a depressed or hopeless fashion? How pervasive is this mood? Are there times when the depression seems to go away? Affect, by contrast, refers to the feeling state that accompanies what we say at a given point. Usually our affect is “appropriate”; that is, we laugh when we say something funny or look sad when we talk about something sad. Mental Status Exam 4. Intellectual Functioning. Clinicians make a rough estimate of others’ intellectual functioning just by talking to them. Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors (as most of us do much of the time)? How is the person’s memory? Clinicians usually make a rough estimate of intelligence that is noticeable only if it deviates from normal, such as concluding the person is above or below average intelligence. Mental Status Exam 5. Sensorium. The term sensorium refers to our general awareness of our surroundings. Does an individual know what the date is, what time it is, where he or she is, who he or she is, and who you are? Most of us are fully aware of these facts. People with permanent brain damage or dysfunction—or temporary brain damage or dysfunction, often because of drugs or other toxic states—may not know the answer to these questions. If the patient knows who he is and who the clinician is and has a good idea of the time and place, the clinician would say that the patient’s sensorium is “clear” and is “oriented times three” (to person, place, and time). Physical Examination A medical examination to determine a person's bodily fitness. Behavioral Assessment Using direct observation to formally assess an individual’s thoughts, feelings, and behavior in specific situations or contexts May be more appropriate than an interview in terms of assessing individuals who are not old enough or skilled enough to report their problems and experiences. ABCs of Observation Self- Monitoring People observe their own behavior to find patterns. Psychological Testing Psychological tests include specific tools to determine cognitive, emotional, or behavioral responses that might be associated with a specific disorder and more general tools that assess longstanding personality features, such as a tendency to be suspicious. Projective Testing Projective tests include a variety of methods in which ambiguous stimuli, such as pictures of people or things, are presented to people who are asked to describe what they see. Follows the theory people project their own personality and unconscious fears onto other people and things. Hermann Rorschach Inkblot Test Rorschach Thematic Apperception Test The TAT is a projective test that asks people to describe ambiguous scenes to reveal their emotions, motivations, and personality. Personality Inventories Self-report questionnaires that assess personal traits. Minnesota Multiphasic Personality Inventory (MMPI) Was developed in the late 1930s and early 1940s and first published in 1943. The Minnesota Multiphasic Personality Inventory (MMPI) is a widely used psychological assessment tool designed to measure various aspects of an individual's personality and psychological functioning. Minnesota Multiphasic Personality Inventory (MMPI) Intelligence Testing Stanford-Binet test Wechsler Adult Intelligence Scale Wechsler Intelligence Scale for Children Wechsler Preschool and Primary Scale of Intelligence Neuropsychological Testing Neuropsychological tests measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction in such a way that the clinician can make educated guesses about the person’s performance and the possible existence of brain impairment. A caution about Labeling and Stigma A related problem that occurs any time we categorize people is labeling.