clinical assessment and diagnosis chapter 3 abnormal psychology
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Clinical Assessment and Diagnosis
Chapter 3
Abnormal Psychology
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Clinical Assessment
Protocols used for evaluation and measurement
Assessing/diagnosing psychological disorders
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Getting Started
What brings the client to the provider?
Discussion of the presenting problem and the client’s history
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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
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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
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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?
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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)
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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
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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
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Physical Exam
Physical problems may mimic psychological disorders
Thyroid issues
Brain lesions/tumors
Dementia
Drug induced conditions
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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
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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
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Overview of Psychological Tests
Projective Tests
Personality Inventories
Intelligence Tests
Neuropsychological Tests
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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
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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
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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
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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
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MMPI
Results in a “code type”
Looking at answers left blank
Excellent reliability, good validity
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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
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Issues in Diagnosis
Diagnostic and Statistical Manual
Reliability/Validity
Some diagnoses have greater reliability/validity than others
Personality Disorders tend to have lower reliability
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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
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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)
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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)
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DSM-V
In progress
Various workgroups: clinicians and researchers
Revisions/new additions