Unit 4: Clinical Assessment and Diagnosis
Discuss reliability and validity as they relate to a classification system.
(+) Reliability and Validity of abnormal behaviour are measured more thoroughly as a result of a defined classification system. Having an established system allows for consistency needed. (-) We must keep in mind that all classification is the product of human invention - a matter of making generalisations based on what we have observed. Our generalisations enable us to make inferences about underlying similarities and differences. Classification is often an ongoing work in progress as new research proves an earlier generalisation to be incomplete or flawed. Formal classification is successfully accomplished only through precise techniques oh psychological, or clinical assessment - that have been increasingly refined over the years.
Advantages and limitations to Objective Personality Tests
(+) They are cost effective, highly reliable, and objective; they also can be scored and interpreted ( and administered) by a computer. (-) Some clinicians, however, find these too mechanic to portray the complexities of human behaviour and their problems accurately. (-) Also, because these tests require a subject to read, comprehend and answer verbal material, patients who are illiterate cannot take the tests. (-) Individual's cooperation is required, and it is possible to distort one's answers to create a particular impression. The validity scales of the MMPI-2 are a direct attempt to counter this. (-) Computerized MMPI assessments also allow room for error. The accumulation of precise actuarial data from an instrument like the MMP-2 is difficult on a computer is time-consuming, and expensive. (-) Due to the complexity of the data, problems can occur during the acquisition which can result in the program not being able to fit a person into a particular profile. This makes it difficult to accumulate enough cases to serve as an actual database. The human element must always come in and interpret data further and monitor assessment.
Describe the major intelligence tests.
(?) *The Wechsler Intelligence scale for Children-Revised (WISC-IV)* and the *Stanford-Binet Intelligence Scale* are widely used in a clinical setting for measuring the intellectual abilities of children The most commonly used test for adults is The *Wechsler Adult intelligence Scale - Revised (WAIS-IV)*. It includes both verbal and performance material and consists of 15 subtests. two of these subsets include 1. Vocabulary (Verbal): This subset consists of a list of words to define that are presented orally to the individual. This task is designed to evaluate knowledge of vocabulary, which is shown to be related highly to general intelligence. 2. Digit Span (Performance): In this test of short-term memory, a sequence of numbers is administered orally. The individual is asked to repeat the digits in the order administered. Another task in the subset involves the individuals remembering the numbers, holding them in their memory, and reversing the order sequence. (+) In cases of intellectual impairment or organic brain damage, this type of testing may be the most crucial diagnostic procedure in the test battery. (-) Individually administered intelligence tests such as these three typically require 2-3 hours to administer, score, and interpret. In many clinical situations, there is not enough time or funding to use these tests. (-) Informatin about cognitive functioning can provide valuble clues to a person's intellectual resources in dealing with problems, yet in many clinical settings, gaining a thorough understanding of clients problems and initiating a treamntet program do not require knowing the kind of detail about intelligence functioning. In these cases intelligence testing in not recommended.
Discuss the advantages and disadvantages of projective personality tests.
(?) Are unstructured in that they rely on various ambiguous stimuli such as ink blots, or vague pictures rather than an explicit verbal question, and in that person's responses are not limited to the "true", "false", or "cannot say" variety. Through their interpretation of these ambiguous materials, people reveal a good deal about their personal preoccupations, conflict, motives, and other personality characteristics. An assumption underlying the use of projective techniques is that in trying to make sense of vague, unstructured stimuli, individuals "project" their own problems, motives, and whiches into a situation. Projective tests are this aimed at discovering the ways in which an individual's past learning and personality structure may lead him or her to organize and perceive ambiguous information from the environment. Prominent among the several projective tests are the 1. Rorschach Ink Blot Test 2. Thematic Apperception Test (TAT) & 3. Scientific Completion test. (+) Projective tests have an important place in understanding *psycho-dynamic* functioning and those that have the necessary trained staff to conduct extensive individual psychological evaluations. (-) Their unstructured nature and their focus on the unique aspects of personality are at the same time their weakness because they make interpretation subjective, unreliable, and difficult to validate. (-) Moreover, projective tests usually require a great deal of time to administer and advanced skill to interpret - both scarce in quantity in many clinical settings.
Summarize the process of integrating assessment data into a model for use in planning or changing treatment.
(?) Clinicians in individual private practice usually assume this complicated task on their own. (?) In a clinic or hospital, assessment data are often evaluated in a staff conference attended by members of the interdisciplinary team concerned with the decision to be made regarding treatment. (1) By putting together all the information they have gathered, they can see a) findings complement each other and form a definitive clinical picture of whether gaps or b) discrepancies exist that require further investigation. (2) The findings of each member and recommendations for treatment are entered into a case record so that it will always be possible to check back and see why a certain course of therapy was undertaken, how accurate it all was, and how valued the treatment decision turned out to be. (2) New assessment data collected during their therapy provide feedback on its effectiveness and serve as a basis for making needed modifications in an ongoing treatment program. Clinical assessment data are also commonly used in evaluating the outcome of therapy and in comparing the effectiveness of different therapeutic and preventive approaches.
3) Psychological tests
(?) More indirect means of assessing psychological characteristics. Scientifically designed psychological tests, as opposed to recreational, are standardised sets of procedures or tasks for obtaining samples of behaviour. Response to the standardised stimuli is compared with others who have comparable demographic characteristics, usually through established test norms or test score distributions. From these comparisons, a clinician can then draw inferences about how much a person's psychological qualities differ from those of a normal reference group. (+) These tests can measure coping patterns, anxiety intellectual function, etc. (-) Although psychological tests are more precise and reliable than interviews or some observational techniques, they are far from perfect. Their value often depends on the competence of the clinician who interprets them. Pathology may be revealed in people who appear to be normal or a general impression of "something wrong" can be checked against more precise information. (+) In general, they are as useful a tool to a psychologist in the same way blood tests, and x rays are to physicians. In all these cases, The two general categories of psychological tests are 1) Intelligence Tests and 2) Personality Tests
The Rorschach Ink Blot test
(?) Named after Hermann Rorschach who initiated the experimental use of inkblots in personality assessment in 1911. The test uses ten inkblot pictures, to which a subject responds in succession after being instructed to tell what the ink blot means to them, what they see, how they feel, and what it makes them think of. This test remains on of the prominent instruments of assessing personality. (+) In the hands of a skilled interpreter, this exam can be useful in uncovering certain psychodynamic issues, such as the impact of unconscious motivation on current perceptions of others. (-) Administrating of this test is complicated and required considerable training. Methods of administrating the test can take hours and vary. The results can also be unreliable due to the subjective nature of the interpretations. Insurance companies do not want to pay for the considerable amount of time needed to administer, score and interpret the data. (-) The Rorschach has also shown to over-pathologize person's taking the test, showing pathology, even when the person is normal. (-) The extent to which this test provides valid information beyond what is available by other, more economical instruments, has not been determined. *Clinical treatments today require a behavioural description rather than a description of deep personality dynamics. Attempts have been made to objectify the Rorschach interpretations by clearly specifying test variables and empirically exploring their relationship to external criteria such as clinical diagnosis. Although considered, open-ended and subjective, it has also been adapted for computer interpretations showing that the computer interpretations tended to be the same as those by the clinicians.
The Thematic Apperception Test (TAT)
(?) Uses a series of simple pictures, some highly representational and others highly abstract, of which a subject is instructed to make up a story. The content of the pictures is highly ambiguous as to actions and motives so subjects tend to project their own conflicts and worries onto it. Several scoring and interpretation systems have been developed to focus on the different aspects of one's subjective stories. (-) It is time-consuming to apply these systems, and there is not evidence that they make a significant contribution. Has issues with reliability and quantifiability. (-) Clinicians usually make a qualitative and subjective interpretation of how the story reflects a person's underlying traits. (-) There is much room for error in such an informal procedure. (-) This technique has been criticized for its dated quality to the test stimuli as the images used were developed int he 1930's and people today may have trouble identifying what is in the pictures.
Discuss the advantages and disadvantages of objective personality tests.
(?) are structured - that is, they typically use questionnaires, self-report inventories, or rating scales in which questions or items are carefully phrased and alternative responses are specified as choices. (+) They involve a far more controlled format that projective devices and thus are more amenable to objective based qualifications. (+) One virtue of such quantification is its precision, which, in turn, enhances the reliability of test outcomes. *The Neuroticism-Extroversion-openness Personality Inventory or (NEO-PI)* is one of these tests that provides information on the major dimensions of personality and is widely used in evaluating personality factors in normal range populations. There are also many objective assessment instruments developed to assess focused clinical problems such as the *Milton Clinical Inventory (MCMI-III)*. This was developed to evaluate the underlying personality dimensions among clients in psychological treatment.
Sentence Completion Test
(?) consist of the beginning of sentences that a person is asked to complete. (+) These tests relate to free association methods and are somewhat more structured than most other projective tests. (+) They help examiners pinpoint important clues to an individual's problems attitudes and symptoms through the content of their responses. (-) Interpretation is often subjective and unreliable. Despite the fact that the test stimuli is standardized, interpretations are usually done in an ad hoc manner and without the benefit of normative comparisons.
MMPI (Minnesota Multiphasic Personalty Inventory)
(?) now called the MMP2 for adults, this test is the most widely used personality test for clinical and forensic assessment and in psychology research in the USA. It is also the instrument taught in most graduate level programs. (?) The original MMPI, a self-report questionnaire, consisted of 550 items covering topics ranging from physical condition and psychological states to moral and social attitudes. Questions were answered as either true or false. Answers to each item were then item analyzed to see which ones differentiated among the groups. 10 clinical scales were constructed on the results, each consisting of items that were answered by one of the patient groups in the direction opposing the predominant response of the normal group. This method of selecting scorable items, known as *empirical keying*, originated with the MMP1 and accounts for much of the instrument's power. (+) It involves no subjective prejudgement about the meaning of a true or false answer... should an examinee's pattern of responses closely approximate that of a particular pathological group, it is a reasonable inference that he or she shares other psychiatrically significant characteristics with that group - may even be a member of that group. Each of these ten scales measures tendencies to respond in a psychologically deviant way. Raw scores on these scales are compared to corresponding scores of the normal population, and the results are plotted on the standard MMPI profile form. This allows the clinician to plot how far from normal the patient performance is on each scale. The MMPI also includes a number of validity scales to detect whether a patient has answered the question straight forward. Clinically, the MMPI is used in several ways to evaluate a patient's personality characteristics and clinical problems. The most typical use of the MMPI is a diagnostic standard.
Main Categories of Axis I and II disorders
* Substance abuse disorders * Disorders secondary to gross destruction or malfunction of brain tissue, as in Alzheimer's or dementia. * Psychological or sociocultural origin disorders having no known brain pathology as a primary causal factor. This can include severe mental disorders for which specific brain pathology has not been dtermined such as major mood disorders *Disorders usually arising during childhood or adolescence, including a broad group of disorders featuring cognitive impairments such as mental retardation and specific learning abilities and a large variety of behavioural problems like Hyperactivity disorder, that constitute deviations from the expected or normal path of development.
PET Scans
*Position emission tomography (PET) scan*. Whereas a CAT scan is limited to distinguishing anatomical features such as the shape of a internal structure, and PET scan allows for an appraisal of how an organ is functioning. provides metabolic portraits by tracking natural compounds, such as glucose, as they are metabolized by the brain or other organs. By revealing different areas of metabolic activity, the PET scan enables a more clear-cut diagnosis of brain pathology by pinpointing sites responsible for seizures, trauma from a head injury, stroke, and brain tumors. The PET may be able to reveal problems that are not immediately apparent anatomically. Use of PET in research of brain pathology has also led to research in Alzheimer's, and may lead to important discoveries about the organic processes underlying the disorder and possible treatment. PET scans have been seen as low values due to their low fidelity picture and their high cost to operate in order to produce the short lives radio-active atoms required for the procedure.
Three Measurement Concepts Important to understanding clinical assessment:
*Reliability*: The degree to which an assessment measure produces the same result each time when evaluating the same thing. Reliability is an index of the extent a measurement instrument can agree that person's behaviour fits a given diagnosis class. If the observation is different, it may mean that the classification criteria are not precise enough to determine whether the suspected disorder is present. *Validity*: The extent to which a measuring instrument actually measures what is is supposed to measure. The degree to which a measure indicates to us something that is clinically important such as helping to predict the future course of the disorder. The classification or diagnosis of schizophrenia, for example, implies a disorder of precise characteristics such as unusual stubborn persistence, with recurrent episodes being common. The validity of a mental health measure usually presupposes reliability. Yet, good reliability isn't always an indicator of validity. Reliable assignment of a person's behaviour to a given class of mental disorder will prove only useful to the extent that the validity of that class has been established through research. *Standardisation*: is the process by which a psychological test is administered, scored, and interpreted in a consistent or "standard" manner. Standardized tests are considered to be fairer in that they are applied consistently and in the same manner to all persons taking them. Many psychological tests are standardized to allow the test user to compare a particular individual's score on the test with a reference population, often referred to as a normal sample. Comparing a particular individual's test score on a distribution of a test score from a large normative population can enable the user to evaluate whether the individuals score is low, average, or high along the distribution of scores (referred to as *T-score Distribution*)
Explain the purpose of classification systems for abnormal behaviour.
1) With an agreed upon classification system, we can be confident that we are communicating clearly. In Abnormal Psychology, classification involves the attempt to define meaningful subvarieties of maladaptive behaviour. Like defining abnormal behaviour, classification of some kind is a necessary first step towards introducing order into our discussion of the nature, causes, and treatment of such behaviour. 2) Makes it possible to communicate about particular clusters of abnormal behaviour in agreed upon relatively precise ways. For example, we cannot conduct research on eating disorders without a clear definition of the behaviour under examination; otherwise, we would not be able to select, for intensive study, persons who display the patterns we hope to understand. 2) Other reasons for classification include gathering data for statistics, on how common types of disorders are and meeting the needs of medical insurance companies
Prototypal Approach for classifying abnormal behaviour
A conceptual entity like a personality disorder depicting an idealized combination of characteristics that more or less regularly occur together in a less-than-perfect or standard way at the level of actual observation. The official diagnostic criteria defining the various recognised classes on mental disorder, although explicitly intended to create categorical entities, more often than not result in prototypal ones. The central features of the variously identified disorders are often vague as are the boundaries separating one disorder from another. Much evidence suggests that a strict categorical approach to identify differences among types of behaviour, normal or abnormal, may well be an unattainable goal. We commonly find that two or more identified disorders regularly occur together in the same individual - known as *comorbidity*. An individual typically does not have two or more entirely separate and distinct disorders at one time.
Aphasia
A disorder where there is a loss of ability to communicate verbally.
1) Discriminate between structured and unstructured interviews for the assessment of psychosocial functioning, and evaluate the relative merits of the two.
Although many clients prefer the freedom to explore as they feel research shows that a more controlled and structured assessment interview yields far more reliable results. *Structured interviews* follow a predetermined set of questions throughout the interview. The beginning statements or introduction to the interview follow set procedures. The themes and questions are predetermined to obtain particular responses. The interviewer cannot deviate from the questions list or procedure. Merit: All questions are asked in a present way and structured so as to allow responses to be quantified and clearly determined. Issue: These tend to take longer and may include long-winded questions. Clients can sometimes be frustrated by the overly detailed questions in areas that are of no concern to them. *Unstructured interviews* are typically subjective and do not follow a predetermined set of questions. The beginning statements of the interview are usually general, and follow up questions are tailored to each client. The content is influenced by the habits of theoretical views of the interviewer. The interviewer does not ask the same questions of each client, rather they subjectively decide what to ask based on the client's response to the previous question. Merit: These types of interviews can be viewed by the client as more attentive to their needs and sensitive to their problems. The spontaneous nature of follow-up questions that emerge can also provide valuable information that wouldn't emerge in a structural interview. Issue: Because the questions are asked in an unplanned way, important criteria needed for the DSM-5 diagnosis may be skipped. Answers based on unstructured interviews are difficult to quantify or compare with responses of clients from other interviews. As a result, unstructured interviews in mental health research are limited. There seems to be widespread overconfidence among clinicians in the accuracy of their own methods. Every rule has an exception, but it is wiser to conduct the interview that is structured.
2) Explain the importance of rating scales in clinical observations.
As is the case with interviews, the use of rating scales in clinical observation and self-reports help both to organise information and to encourage reliability and objectivity. these may also be made not only as part of an initial evaluation, but also to check on the course or outcome of treatment. The formal structure keeps observer inferences to a minimum. The most useful rating scales are those that enable a rate to indicate not only the presence or absence of a trait or behaviour but also its prominence or degree. The * Breif Psychiatric Rating Scale (BPRS)* is one of the most widely used rating scales for recording an observation in clinical practice. It provides structure and quantifiable format for rating clinical symptoms. The distinct pattern of behaviour reflected enables clinicians to make a standardised comparison of their patient's symptoms with the behaviour of others patients. The BPRD is extremely useful, especially for the purpose of assigning patients to treatment groups on the basis of similarity in symptoms. However, it is not widely used for making treatment or diagnostic decisions in clinical practice. The *Hamilton Rating Scale for Depression (HRSD)*, is similar but more specific. It is one of the most widely used procedures for selecting clinically depressed research subjects and also for assessing the response of such subjects to various treatments.
List types of psychosocial assessments.
Assessment Interviews: Clinical Observation: Psychological Tests:
Clinical Assesment
Assessment it an ongoing process, and is important at different points in the treatment. At the start of an assessment, an attempt is made to identify the main dimensions of a client's problem and to predict the probable course of events under various conditions. This is when critical decisions are made such as what treatment approach should be offered, if the problem will require hospitalization, to what extent family will need to be included as co-clients etc. A pretreatment assessment also creates a baseline for various psychological functions so that the effects of treatment can be measured comparing pre and post treatment assessment is an essential feature of many research projects designed to evaluate different therapies
Dimensional Approach for abnormal behaviour
Assumed that a person's typical behaviour is the result of differing strengths or intensities of behaviour along several definable dimension such as mood, emotional stability, aggressiveness, gender identity, anxiousness, interpersonal trust, clarity of thinking and communication, social introversion, and so on. The important dimensions, once established, are the same for everyone. People are assumed to differ from one another in their configuration or profile of these dimensional traits ( ranging from very low to very high), *not* regarding behavioural indications of a corresponding "dysfunctional" entity presumed to underlie and give rise to the disorders patterns of behaviour. "Normal" is discriminated from "Abnormal", then regarding precise statistical criteria derived from dimensional intensities among unselected people in general, most of whom may be presumed to be close to average or mentally "normal". (+) The dimensionally based diagnosis has the incidental benefit of directly addressing treatment options. Because the client's psychological profile will usually consist of defiantly high and low points, therapies can be designed to moderate those of excessive intensity and to enhance those that consider deficit status. In taking the dimensional approach, it would be possible to discover that such profiles tend to cluster together in types - and even with some of these types being correlated, though imperfectly, with recognisable sorts of gross behavioural malfunction. (-) It is highly unlikely, however, that any individual's profile will exactly fit the narrowly defined type or that the types identified will not have some overlapping features.
Categorical Classification for abnormal behaviour
Assumes (1) that all human behaviour can be divided into categories of healthy and disordered, and (2) that within the later there exists discrete, non-overlapping classes or types of disorder that have a high degree of within-class homogeneity in both symptoms displayed and the underlying organization of the disorder identified.
Neurological approaches to assessment of physical problems.
Because brain pathology is sometimes involved in some mental disorders, a specialized neurological examination can be administered in addition to the general medical examination. This may involve getting an *electroencephalogram (EEG)* to assess brain wave patterns in awake and sleeping stages to take a graphical record of the brain's electrical activity. It is obtained by placing electrodes on the scalp and amplifying the minute brain wave impulses from various brain areas. Much is known about what is normal in these patterns in waking and sleeping stages as well as under various conditions of sensory stimuli. Significant divergences from these normal patterns can reflect abnormality that affects brain function such as that caused by a brain tumor or other lesion. When the EEG reveals a *dysrhythmia*, or irregular pattern, in the brain's electrical activity, other specialized techniques may be used in an attempt to arrive at a more precise diagnosis of the problem. These specialized techniques include: *Anatomical Brain Scans* *PET scans* and *Functional MRI*
Explain the ethical issues involved in an assessment.
Because of the impact that assessment can have on the lives of others, it is important that those involved keep several factors in mind in evaluating test results. 1. Potential Cultural Bias of the Instrument or the Clinician: There is a possibility that an instrument used may not elicit valued information for a patient from a minority group. A clinician from one background may also have trouble assessing objectively the behavior of a person from another. It is important that instruments used have been proven to work with individuals from a minority. 2. Theoretical Orientation of the Clinician: Assessment is influenced by the clinician's assumptions, perceptions, and theoretical orientation. Different treatment recommendations are likely to result because of different orientations of the practitioner. 3. Underemphasis on the External Situation: Many clinicians overemphasize personality traits as the cause of a patient's problems without paying enough attention to the possible role of stressors and other circumstances on the patient's personality, which some assessment techniques encourage, can divert attention from potentially critical environmental factors. 4. Insufficient Validation: Some assessment procedures in use today have not been sufficiently validated strictly. 5. Inaccurate Data or Premature Evaluation: There is always the possibility that some assessment data may be inaccurate or that the team leader might choose to ignore some test data in favor of other information. Some risk is always involved in making predictions for an individual on the basis of group data. Inaccurate data or premature conclusions may not only lead to a misunderstanding of the patient's problem but also close off attempts to get further information, with possibly grave consequences for the patient.
Diagnosis Interviews
Can be structured or unstructured In unstructured interviews, the examiner follows not preexisting plan with respect to context or sequence of the problems introduced. They are freewheeling and questions are asked as they occur. Many clinical examiners prefer this approach because it allows them to follow idiosyncratic leads. However, the information gained in such free association techniques is limited to the context of the interview. Should another clinician conduct another unstructured interview, they may come up with a different clinical picture. Structured diagnostic interviews prove the client in a manner that is highly controlled. Guided by a master plan, the clinician uses a structured interview to determine whether the person's symptoms and signs fit into diagnostic criteria that are more precise and operational.
Acute
Describes mental disorders that are relatively short in their duration, usually under 6 months, such as a transitory adjustment disorder. In some cases, these are high in intensity.
Speech Sound Perception Test
Determines whether an individual can identify spoken words. nonsense words are presented on a tape recorder, and the subject is asked to identify the presented word in a list of four printed words. This task measures the subjects concentration, attention, and comprehension.
Explain what is meant by the rapport between the clinician and client, and outline the components of a relationship that leads to a good rapport.
For the psychological assessment to proceed effectively and to provide a clear understanding of behaviour and symptoms, the client being evaluated must feel comfortable with the clinician. *Involves building a trusting relationship. The client must feel that the testing will help the practitioner gain a clear understanding of his or her problems and must understand how the tests will be used, and how the psychologist will incorporate them into clinical evaluation. * To build rapport, the clinician should explain what will be happening during the assessment and how the information gathered will help provide a clearer picture of the problems the client is facing. *By doing this, clients can be assured that the feelings, beliefs, attitudes, and personal history that they are disclosing will be used appropriately, will be kept strictly confidential, and will be made available only to therapists or others involved in the case. * People being tested are usually highly motivated to be evaluated and like the results of testing. They are generally more eager for a definition to their discomfort. *Moreover, providing test feedback in a clinical setting can be an important element in the treatment process - and patients tend to improve just from gaining perspective. However, by not establishing a good rapport, results can be impacted by the with draw of a patient or their lack of confidence to disclose pertinent information.
MMPI 2
In response to psychodynamically oriented clinicians feeling that the test did not take into account the complexities of the individual, and the behaviourist oriented clinicians who felt the test was too oriented to measuring mental construct and traits, the MMPI 2 was developed for adults and adolescents. The original 10 clinical scales were kept, clinical scales were re-worded but generally kept the same, stability of meaning is observed for the standard of validity scales, and three additional scales to detect tendencies to respond untruthfully to some items have been introduced.
General Physical Examination approaches to assessment of physical problems.
In some situations with certain psychological problems, a medical evaluation is necessary to rule out the possibility that physical abnormalities may be causing or contributing to the problem. These may include general or specific examinations aimed at assessing the structural (anatomical) and functional ( Physiological) integrity of the brain as a behaviorally significant physical system. In cases where physical symptoms are part of the presenting clinical picture, a referral for a medical evaluation is recommended. A physical examination consists of the kinds of procedures most of us have experienced when getting a check up. This portion of the assessment is important for disorders with physical problems such as psychologically based physical conditions, addictive, and organic brain syndromes. In addition, a variety of organic conditions, including hormonal irregularities, can produce behavioural symptoms that mimic those of a mental disorder.
Clinical Diagnosis
Is the process through which a clinician arrives at a general summary classification of patients symptoms by following a clearly defined system such as the DSM-5-TR or ICD-10 (Internal classification of Disease)
Tactual performance test
Measures a subject's motor speed, response to the unfamiliar, and ability to learn and use tactile-kinesthetic clues. The test surface is a board that has spaces for ten blocks of varies shapes. The subject is blindfolded and asked to place the blocks into the correct grooves in the board. Later the subject is asked to draw the blocks and the board from tactile memory.
Finger Oscillation Task
Measures the speed at which an individual can depress a lever with the index finger. Several trials are given from each hand.
Rythm test
Measuring attention and sustained concentration through auditory perception tasks. It includes 30 pairs of rhythmic beats that are presented on a tape recorder. The subject is asked whether the pairs are the same or different.
Assessment of physical organisms
Medical and neuro psychosocial sciences have developed new technology and procedures used to assess organic brain damage. These hold great promise for detecting and evaluating dysfunction and increasing our understanding. Neuropsychological testing provides a clinician with important behavioural information on how organic brain damage is affecting a person's present functioning.
Problem of Labeling/ Limited Usefullness
One important criticism is that psychiatric diagnosis is little more than a label applied to a defined category of socially disapproved or otherwise problematic behaviour. This label described neither the person nor any underlying pathological conditions the persona necessarily harbours but, rather, some behavioural pattern associated with that person's current level of functioning. Yet once a label is assigned, it may close off further inquiry and opens the doors for others assumptions regarding the patient that may or may not be accurate.This can make it hard to look at an individual objectively. The diagnosis may also amplify the behaviour as one starts to act in the stigmas and expectations of that role. It should also be noted that the DSM can be limited in usefulness, as the DSM diagnosis is only the first step in a comprehensive evaluation. To formulate an adequate treatment plan, a clinician will require considerable more information about the person being evaluated far beyond what the DSM will offer. Our medical and insurance system makes diagnosis a necessary step, but it is not the only step, nor the most important.
Chronic
Refers to long-standing and often permanent disorders such as Alzheimer's dementia and some forms of schizophrenia. The term can also be applied to generally low-intensity disorders because long-term difficulties are often this sort.
Explain the DSM classification of mental disorders. - Symptoms & Signs
Specifies what subtypes of mental disorder are currently officially recognised and provides, for each, a set of defining criteria in the United States and some other countries. Initially, the DSM was designed to remove, as much as possible, the aspect of subjective vague and jargon-ridden personal judgement by adopting an operational method of defining the various disorders. However it is in fact, a prototypal classification with much fuzziness of boundaries and considerable interpretation, or overlap, of the various categories of disorder it identifies. --------- The criteria that define the recognised categories consist of symptoms and signs. The term *symptoms* usually refers to the patient's *subjective description*, and the complaints that she or he presents about what is wrong. *Signs* are the *objective observations* that the diagnostician may make either directly or indirectly. To make any given diagnosis, the diagnostician must observe the particular criteria - the symptoms and signs that the DSM indicates must be met. The DSM today is now more comprehensive and more finely differentiated into subsets of disorders. Additional versions also have allowed for cultural and ethnic considerations. There are limits to the DSM on the extent to which a conceptually strict categorical system can adequately represent the abnormalities of behaviour to which humans are subject. Real problems and real patients do not fit so precisely into a list of signs and symptoms. Blends of disorders are often extremely common. Never the less, the DSM treats the two as distinct, and as a consequence, a person who is clinically two categories many receive two diagnoses.
Episodic and Recurrant
Terms used to describe unstable disorder patterns that tend to come and go, as with some mood and schizophrenic conditions.
Halstead Category Test
The *Halstead - Reitan neuropsychological test battery*, for example, is comprised of several tests and variables from which an index of impairment can be computed. In addition, it provides specific information about subjects functioning in several skill areas. Measures a subject's ability to remember the material and can provide clues as to his or her judgement and impulsivity. The subject is presented with a stimulus that suggests a number between 1 and 4. The subject presses a button indicating the number she or he believed is suggested. A correct choice is followed by the sound of a peasant doorbell and an incorrect by a loud buzzer. The person is required to determine from the pattern of buzzers and bells what the underlying principles of the correct choice are.
Functional MRI (fMRI)
The MRI could reveal brain structure, but not brain activity as originally applied, leaving clinicians dependent on PET scans. Improving on this, the fMRI *measures changes in local oxygenation (i.e., blood flow)* on specific areas of the brain tissue that in turn depend on neuronal activity in those specific regions. (+) Ongoing psychological activity, such as sensations, and thoughts, can thus be mapped, at least in principle, revealing the specific areas of the brain that appear to be involved in their neurophysiological process. Because the measurement of change is critically time dependent in this context, the emergence of the fMRI required the development of high-speed devices for enhancing the recording process, as well as a computerised analysis of incoming data. Optimism about the impact of fMRI's in mapping cognitive processes and is thought to be more promising in depicting brain abnormalities than currently used neuropsychological procedures. (-) fMRI results are quite sensitive to instrument errors or inaccurate observations as a result of slight movements of the person being evaluated. Results are often difficult to interpret. Although differences can be found between a control sample and experimental group, details providing specific information are not provided. Lacks effective and pragmatic methodology in assessing cognitive process and is ambiguous in its results. the fMRI is thus not considered to be a valid or useful diagnostic tool for mental disorders; however is shows great promise for understanding brain functioning.
The 5 Axis of the DSM IV-TR for evaluation
The first three axes assess an individual's present clinical status or condition. Axis I: *The particular clinical syndrome* or other condition that may be a focus of clinical attention. Axis I conditions are roughly analogues to the various illnesses and diseases recognised in general medicine. Axis II: Personality Disorders. A very broad group of disorders that encompass a variety of problematic ways of relating to the world. Some of these may refer to early developing, persistent, and pervasive maladaptive patterns of disregard. Axis II provides means of coping for long-standing maladaptive personality traits that may or may not be involved in the development and expression of an Axis I disorder. Mental retardation is also included in this Axis. Axis III: General Medical Considerations: Any general medical conditions potentially relevant to understanding or managing the case. Axis III may be used in conjunction with Axis I qualified by the phrase "due to". The last two Axis are used to assess broader aspects. Axis IV: Psychosocial and environmental problems. This group deals with the stressors that may have contributed to the current disorder, particularly those that have been present during the prior year. Axis V: Global assessment of functioning. This is where clinicians indicate how well the individual is coping in the present time. A 100-point global assessment of functioning or (GAF) scale is provided for the examiner to assign a number summarising a patient's over all ability to function. Axis IV and V are significant additions to the DSM-III. Knowing what frustrations and demand an individual is facing important for understanding the context with the problem behaviours has developed. And general level of functioning conveys important information that is not necessarily contained in the entries of the other axis.
2) Discuss various approaches to the clinical observation of behaviour and identify the advantages of each.
The main purpose is to learn more about the person's psychological functioning by attending to his or her appearance and behaviour in various contexts. 1) Clinical observation is the objective description of the person's appearance or behaviour - personal hygiene and emotional responses, and any depression, anxiety, aggression, delusions, etc. they may manifest. Ideally, these observations take place in a neutral environment but are more likely to be administered at a hospital. For example, a brief observation in made in the hospital, and a more detailed observational account is made in the ward. 2) Some practitioners prefer a more controlled, rather than naturalistic, behavioural setting. These analogue situations are designed to specifically yield information about the person's adaptive strategies, and may include staged role-playing, event reenactment, family interaction assignments, or think-aloud procedures. 3) In addition to making their observations, many clinicians enlist their clients to help by providing them instructions in *Self-monitoring* or self-observation. This is done through the personal objective report of their behaviour, feelings, thoughts, etc. as they occur in a natural setting. or a client may be asked to fill out a more or less formal self-report or checklist concerning problematic experiences. May instruments have been published for this purpose. This method is valuable for treatment planning and in determining the kind of situations in which maladaptive behaviour is likely to be evoked and may have therapeutic benefit if all the right questions are asked, and if people are willing to disclose information about themselves.
Anatomical Brain Scans
These are radiological technologies such as *Computerized axial tomography (CAT) scans*. Through the use of X-rays, CAT scan reveals parts of the brain that might be diseased. This has provided rapid access, without surgery, to information about the location and extent of anomalies in the brain. The procedure involves the use of computer analysis as Xray beams cross sections of the brain to produce images that can be interpreted by clinicians. *Magnetic Resonance Imaging (MRI)*. Involves the precise measurement of variations in magnetic fields that are caused by the varying amounts of water content of various organs parts of organs. As a result, we can non-invasively visualize all but the most minute abnormalities of brain structure. The images produced are frequently sharper because of superior ability to differentiate subtle variations in soft tissue. The MRI is also a far less complicated to administer and does not subject the patient to ionizing radiation. It has been especially useful in identifying degenerative brain processes and thus has considerable potential to illuminate the contribution of brain abnormalities to nonorganic psychoses such as schizophrenia. MRI's can still be problematic as the machines have been known to cause claustrophobia and some studies raise the question of whether MRI's tell us as much about the body as doctors say they do - but are driven by health care policy and insurance reimbursement.
Formal Diagnostic Classification of Mental Disorders
Today there are two major psychiatric classification systems used to classify Mental disorders The (ICD-10) International Classification of Disease system and the (DSM) Diagnostic and Statistical Manual for Mental Disorders. The ICD-10 system is widely used in Europe and other international companies, and the DSM is the standard guide for the USA. Both are similar in many respects as they both use symptoms as the focus of classification and dividing problems into different facets. Yet, certain differences in the way symptoms are grouped in these two systems can sometimes result in different classifications. We focus on the DSM.
Describe the influence of professional treatment orientation on the assessment process.
Treatment orientations impact how clinicians go about their assessments. For example, a biologically oriented clinician is likely to focus on a biological assessment aimed at determining the underlying organic malfunctioning as a cause of maladaptive behaviour. Where a psychoanalytically oriented clinician may choose unstructured personality assessment techniques to identify intrapsychic conflicts. Not all clinicians are limited by their orientation, however, they can follow this general trend and matter of emphasis.
Psychosocial approaches Assesment
Use in cases where the psychological difficulty is thought to result from *nonorganic causes*. attempts to provide a realistic picture of an individual in interaction with his or her social environment. T This picture includes relevant information about personality make up and present level of functioning, as well as information about the stressors and resources in their life situation. Step 1) Assessment interview: Face to face. Clinicians absorb as much as they can about the patients situation, behaviour and personality. Present feelings, attitudes, memories, demographical facts - and try to fit these into a meaningful pattern. The interviews may be flexible and impromptu, or tightly controlled and structured using standardized interview formats whose reliability has been established. Step 2) Starting with a technique such as a clinical interview, clinicians then formulate a hypothesis and discard or confirm as they proceed. clinicians later select more specific assessment tools. Such tools include: 1) Assessment interviews 2) Clinical observation of behaviour & 3) Psychological tests
Psychosocial Assessment Refers to
a procedure by which clinicians, using psychological tests, observations, and interviews, develop a summary of a client's symptoms and problems.
Describe the basic elements of clinical assessment, including: a) its purpose, b) the relationship between diagnosis and assessment, c) the types of information sought, and d) the different types of data of interest.
a) *Asks the question of what the clinician need to know? * Identifies the major symptoms and behaviour the client is experiencing * Is it short or situational or a pervasive long-term disorder * Evidence of deterioration of cognitive functioning? * Do the individual's symptoms fit into the diagnostic patterns of the DSM-5-TR, etc. b) Diagnosis and Assessment info is sought to classify the problem: * Help clinicians plan and manage the appropriate treatments. * Reveals range of diagnostic problems represented in a client population, to treatment facilities available can be determined. *Formal diagnosis and categorization is necessary before insurance will over claimed treatments. The nature of the difficulty thus must be clearly understood *Diagnosis and assessment are interrelated. Without assessment, we cannot diagnose, but a treatment plan needs more than a diagnosis alone, it also needs assessment. c) Take a social and behavioural history: * Can be more important than diagnosis. * History should include, *Long term Personality Characteristics* (maladaptive tendency), AND *Social Context* and environmental demands that are typically placed on the person including stressors. The diverse bits of information must then be integrated to describe the current situation -> hypothesises of why -->while also predicting their behaviour in the future if treated or left unkept. * Decisions about treatment are then decided * The nature of clinical assessments varies with the problem and the treatment agency's facilities. d) Taking into Account Cultural Factors or *Cultural competency* *Where testing procedures are adapted to culturally diverse clients. *Clinicians must consider various factors such as test-taking abilities, situational, linguistic, and cultural differences, that may affect judgements or accuracy of client interpretations. * Procedures used need to be appropriate fo the clients. * Fairness of instruments used between diverse groups must be addressed regarding possible performance differences between groups.
Differing models of classification.
currently, there are three basic models of classification for abnormal behaviour: *Categorical*, *Dimensional Approach*, and *Prototypal Approach*.
1) Reliability of assesment interviews
may be enhanced by the use of *rating scales* that help focus inquiry and quantify the interview data. For example, the person may be rated on 3, 5, or 7 point scale with respect to self-esteem, anxiety, and various other characteristics. Such a structured and preselected format is particularly effective in giving a comprehensive impression or profile of the subject and his or her life situation in revealing specific problems or crisis that may require immediate therapeutic intervention. Clinical interviews can be subject to error because they rely on human judgement to choose the questions and processes the information. Different clinicians have often arrived at different clinical diagnosis on the basis on interview data. It is for this reason that the recent versions of the DSM have emphasises an operational assessment approach, one that specifies observable criteria for diagnosis and provides specific guidelines for making judgements.
Personality tests
there are a great many tests designed to measure personal characteristics other than intellectual ability. It is customary to group these personality tests into projective and objective measures.
1) Assessment Interviews
this is often considered the central element of the assessment process, usually involving a face to face interaction in which a clinician obtains information about various aspects of a client's situation, behavior, and personality. The interviews may be flexible and impromptu, or tightly controlled and structured using standardized interview formats whose reliability has been established.
Neuropsychological Examination approaches to assessment of physical problems.
used for Behavioural and psychological impairments due to *organic brain abnormalities* may become manifest before any organic brain lesion is detectable by scanning or other means. Reliable techniques are needed to measure alterations in behavioural or psychological functioning that had occurred because of the organic brain pathology. Involves the use of various testing devices to measure a person's cognitive, perceptual, and motor performance as clues to the extent and location of brain damage. In instances of known or suspected organic brain involvement, a clinician will administer a test battery testing standardized tasks, particularly perceptual and motor skills. Can give valuable clues about any cognitive or intellectual impairment following brain damage. and even can provide clues to probable location. Many prefer to administer a highly individualized array of tests, depending on the patient's case history while others administer preselected standard tests, to sample in a systematic way, a broad range of competencies known to be affected by various types of brain injuries. Using a set of standardised tests has many clinical advantages, but can compromise flexibility.
