Abnormal Psychology Chapter 4- Clinical Assessment and Diagnosis Study Guide
Clinical Diagnosis
The process through which a clinician arrives at a general "summary classification" of the patient's symptoms by following a clearly defined system such as DSM-5 or ICD-10.
NEO-PI (Neuroticism-Extroversion-Openness Personality Inventory), Millon Clinical Mutliaxial Inventory (MCMI-III) and the MMPI, MMPI-2 and MMPI-A (Minnesota Multiphasic Personality Inventory.)
What are objective personality tests?
Clinical interviews and behavior observation.
What are the most widely used and flexible psychosocial assessment methods?
Wechsler Intelligence Scale for children - revised (WISC-IV) and the current edition of the Stanford-Binet Intelligence scale are widely used in clinical settings for measuring the intellectual abilities of children. The most commonly used assessment for measuring adult intelligence is the Wechsler Adult Intelligence scale - revised (WAIS-IV).
What are the most widely used examples of intelligence tests?
Minnesota Multiphasic Personality Inventory (MMPI)
The most widely researched (empirically validated) and clinically used of all personality tests. Originally developed to identify emotional disorders (still considered its most appropriate use), this test is now used for many other screening purposes. This is one of the major structured inventories for personality assessment and is now called the MMPI-2 for adults after a revision in 1989. It is the prototype and the standard for this class of instruments. The MMPI was introduced for general use in 1943 by Stark Hathaway and JC McKinley, it is today the most widely used personality test for clinical and forensic assessment and for psychopathology research in the United States. The MMPI-2 is also the personality assessment instrument most frequently taught in graduate clinical psychology programs. International use of the revised inventory is increasing rapidly, over 32 translations have been made since it was published in 1989. It is used in over 46 countries. The original MMPI was translated over 150 times.
Are these symptoms a situational problem precipitated by some environmental stressor such as divorce or unemployment, a manifestation of a more pervasive and long-term disorder, or some combination of the two? Is their any recent deterioration in cognitive functioning? What is the duration of the current complaint and how is the person dealing with the problem? What, if any prior help has been sought? Are there indications of self-defeating behavior and personality deterioration, or is the individual using available personal and environmental resources in a good effort to cope? How pervasively has the problem affected the person's performance of important social roles? Does the individual's symptomatic behavior fit any of the diagnostic patterns in the DSM-5?
After the presenting problem (major symptoms and behavior the client is experiencing) is discussed first, then what does a clinician need to know?
There is always potential cultural bias of the instrument or the clinician. Some psychological test may not elicit valid information for a patient from a minority group. The clinician from one sociocultural background may have trouble assessing objectively the behavior of someone from another background. It is important to ensure that the instrument can be confidently used with persons from many minority groups.
Are there concerns over cultural biases in some psychological tests?
The techniques described, such as anatomical brain scans, EEG, pet scans and the functional MRI all have shown success in identifying brain abnormalities that are very often accompanied by gross impairments in behavior and varied psychological deficits.
Aside from the Neuropsychological Examination, what primarily are the other types of neurological examinations and testing used for?
Psychosocial assessment attempts to provide a realistic picture of an individuals interaction with his or her social environment. This picture includes relevant information about the individual's personality make up and present level of functioning, as well as information about the stressors and resources in his or her life situation. Clinicians act as a puzzle solver, absorbing as much information about the client as possible - present feelings, attitudes, memories, demographic facts - and trying to get all the pieces together in a meaningful pattern. They will typically formulate hypotheses and discard or confirm as they proceed. They will start with a global technique such as a clinical interview, clinicians may later select more specific assessment tasks or tests.
Define psychosocial assessment:
Reliability
Degree to which a measuring device produces the same result each time it is used to measure the same thing or when two or more different raters use it. A psychological test or measurement construct needs to show reliability in order to be effective. Reliability is an index of the extent to which a measurement instrument can agree that a person's behavior fits a given diagnostic class. If the observations are different, it may mean that the classification criteria are not precise enough to determine whether the suspected disorder is present.
Assessment interviews are often considered the central element of the assessment process and usually involve a face-to-face interaction in which a clinician obtains information about various aspects of a client's situation, behavior and personality. The interviewer may vary from a simple set of questions or prompts to a more extended and detailed format. It may be relatively open in character, with an interviewer making moment to moment decisions about his or her next question on the basis of responses to the previous one or it may be more tightly controlled and structured so as to ensure that a particular set of questions is covered. The interviewer may choose from a number of highly structured, standardized interview formats whose reliability has been established in prior research.
Describe assessment interviews:
One of the traditional and most useful assessment tools that a clinician has available is direct observation of a clients characteristic behavior. The main purpose of direct observations is to learn more about the persons psychological functioning by attending to his or her appearance and behavior in various contexts. In clinical observation, the clinician provides an objective description of the person's appearance and behavior- her or his personal hygiene and emotional responses and any depression, anxiety, aggression, hallucinations, or delusions she or he may manifest. Ideally, clinical observation takes place in a natural environment, such as a classroom or home, but is more likely to take place upon admission to a clinic or hospital.
Describe clinical observation of behavior:
Like the assessment interview described earlier, diagnostic interviews are of two general types: unstructured and structured. With the unstructured interview, the examiner follows no pre-existing plans with respect to content and sequence of the probes introduced. It is free willing. They ask questions as they occur to him or her, in part on the basis of the responses to previous questions. Many clinical examiners prefer this unfettered approach because it enables them to follow perhaps idiosyncratic leads. The information that the interview yields is limited to the content of that interview. Another clinician might come up with a completely different clinical picture using this unstructured style of the exact same patient. However, with a structured interview, the interview is given in a manner that is highly controlled. It is guided by a master plan with exact wording, it is more structured typically seeking to discover if the persons symptoms and signs fit diagnostic criteria that are more precise and operational then in the past. The use of more precise criteria and of highly structured and diagnostic interviewing has substantially improved diagnostic reliability, but the structured interview format is still used only sporadically in routine clinical work . The precision of clinical research, including epidemiological research has profited enormously from these developments. A number of structured diagnostic interviews have been developed that can be used in various contexts in clinical and research situations, a popular instrument has been the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), published by the WHO which enables the diagnostician to arrive at an ICD-10 diagnosis.
Describe the differences between structured and unstructured diagnostic interviews?
Assigning a formal diagnostic classification is much less important than having a clear understanding of the person's behavioral history, intellectual functioning, personality characteristics, and environmental pressures and resources. You must have more than a diagnostic label. It needs to be an objective description of the person's behavior. Are they being unresponsive or uncooperative, how do they respond to others, are there excesses in behavior, deficits, is it appropriate? Excesses, deficits and appropriateness are key dimensions to be noted if the clinician is to understand the particular disorder that has brought the individual to the clinic or hospital. A clinician needs to look into the details of one's personality and their social context.
Describe the important elements in a social or behavioral history:
These tests are used by neuropsychologist administrators to look at the person's performance on standardized tasks, particularly perceptual-motor tasks, can give valuable clues about any cognitive and intellectual impairment following brain damage and the probable location of the damage in the brain. (Though MRI's, Pet scans and other physical tests may be more effective in determining exact location.) Behavioral and psychological impairments due to organic brain abnormalities may manifest before any organic brain lesions detectable by scanning or other means. Reliable techniques are needed to measure any alteration in behavioral or psychological functioning that has occurred because of the organic brain pathology. This need is met by a growing cadre of psychologists specializing in neuropsychological assessment.
Describe the use of neuropsychological tests in evaluating the behavioral effects of organic brain disorders.
Clinical picture
Diagnostic picture formed by observation of patient's behavior or by all available assessment data.
In a clinical situation, people are highly motivated by evaluation and like to know the results of the test so that a they might have insight into the situation. This is an important element in the treatment process, providing some definition for their discomfort. When they are given feedback they tend to improve just from the perspective gained and can be a powerful clinical intervention. Getting test feedback can show a significant decline in reported symptoms and increased measure in self-esteem level as a result of having a clearer understanding of their own resources.
Does providing test feedback to clients aid them in their adjustment?
Validity
Extent to which a measuring instrument actually measures what it purports to measure. The psychological test or classification system must be valid. The degree to which a measure accurately conveys to us something clinically important about the person whose behavior fits the category, such as help in predicting the future course of the disorder. The validity of a mental health measure or classification presupposes reliability. If clinicians can't agree on the class to which a person with a disorder's behavior belongs, then the question of validity of the diagnostic classifications under consideration become irrelevant. On the other hand good reliability does not guarantee validity. Reliable assignment of a person's behavior to a given class of mental disorder will prove useful only to the extent that the validity of that class has been established through research.
Neurological Examination
Examination to determine the presence and extent of organic damage to the nervous system.
The focus would shift to the dysfunctional thoughts supposedly mediating those patterns.
How might a cognitively oriented behaviorist assess a given client?
Rating scales
Formal structure for organizing information obtained from clinical observation and self-reports to encourage reliability and objectivity. The use of rating scales when interviewing a client helps focus inquiry and quantify the interview data. A structured and preselected format is particularly effective in obtaining a comprehensive impression or "profile" of the subject and his or her life situation and in revealing specific problems or crisis - such as marital difficulties, drug dependence, or suicidal fantasies - that may require immediate therapeutic intervention. Clinical interviews can be subject to error because they rely on human judgment to choose the questions and process the information. Evidence of this unreliability includes the fact that different clinicians have often arrived at different formal diagnoses on the basis of the interview data that they elicited from a particular client. It is chiefly for this reason that recent versions of the DSM have emphasized an "operational" assessment approach, one that specifies observable criteria for diagnosis and provides specific guidelines for making diagnostic judgments. ''Winging" it has limited use in this type of assessment process. The operational approach leads to more reliable psychiatric diagnoses, perhaps at some cost in reduced interviewer flexibility. Also remember, it is important to consider racial or ethnic factors when conducting diagnostic interviews. The use of rating scales in clinical observation and in self reports help both to organize information and to encourage reliability and objectivity. The formal structure of a scale is likely to keep observer inferences to a minimum. The most useful rating scales are those that enable a rater to indicate not only the presence or absence of a trait or behavior but also it's prominence or degree. Ratings like these may be made not only as part of an initial evaluation but also to check on during the course or outcome of treatment.
Halstead-Reitan Battery for adults -battery for adults which is composed of several tests and variables from which an "index of impairment" can be computed. In addition, it provides specific information about a subjects functioning in several skill areas. It is made up of a group of tasks such as the following: Halsted category test, tactual performance test, rhythm test, speech sounds perception test, and finger oscillation task.
Give an example of one standard procedure of a neuropsychological standard test.
NEO-PI (Neuroticism/Extraversion/Openness Personality Inventory) provides information on the major dimensions of personality and is widely used in evaluating personality factors in normal range populations. The Million Clinical Multiaxial Inventory (MCMI-III) was developed to evaluate the underlying personality dimension among clients in psychological treatment or prior to the beginning of therapy. This objective assessment has been developed to assess focused clinical problems. However, the most widely used personality assessment instrument, is the MMPI-2.
Give some examples of objective personality test:
A subjects responses to the standardized stimuli are compared with those of other people who have comparable demographic characteristics, usually determined through established test norms or distributions. A clinician can then draw inferences about how much the person's psychological qualities differ from those of a reference group, typically a normal one. It can measure coping patterns, motive patterns, personality characteristics, role behaviors, values, levels of depression or anxiety, and intellectual functioning. Advances in technology of test development have been made to create instruments of acceptable reliability and validity to measure almost any conceivable psychological characteristic on which people may vary. Many procedures are available in computer-administered and computer-interpreted format. Although psychological tests are more precise and more reliable than interviews or some observational techniques, they're far from perfect tools. Their value often depends on the competence of a clinician who interprets them. They are a very useful diagnostic tool for psychologists, similar to blood tests, x-rays and MRIs to physicians. But the pathology may be revealed in people, who otherwise appear to be normal, or a general impression of "something wrong" can be checked against more precise information.
How are psychological tests used?
There's always the possibility that some assessment data and any diagnostic label or treatment based on them may be inaccurate or that the team leader might choose to ignore test data in favor of other information. Some risk is always involved in making predictions for an individual on the basis of group data or averages. Inaccurate data or premature conclusions may not only lead to a misunderstanding of a patient's problem, but also close off attempts to get further information, with possibly grave consequences for the patient.
How can inaccurate data or premature evaluation impact the assessment on a client?
Research projects that show the results of comparison of post treatment with pretreatment assessments.
How can one evaluate the effectiveness of various therapies?
Assessment is inevitably influenced by clinicians assumptions, perceptions, and theoretical orientation. For example, a psychoanalyst and a behaviorist might assess the same behaviors quite differently, and different treatment recommendations are likely to result.
How can the theoretical orientation of a clinician impact assessment?
Clinicians and individual private practice normally interpret assessment data and integrate it in to a working model for use in planning on their own. In a clinic or hospital setting assessment data are often evaluated in a staff conference attended by members of an inter-disciplinary team. By putting together all the information that has been gathered, the team can see whether the findings complement each other and form a clinical picture along with recommendations for treatment. Because of the impact such an assessment can have on the lives of others, it is important for those involved to keep several ethical factors in mind when evaluating test results.
How do practitioners integrate assessment data into treatment planning?
Clinical assessment is one of the most important and complex responsibilities of mental health professionals. The extent to which a person's problems are understood and appropriately treated depends largely on the adequacy of the psychological assessment.
How important is clinical assessment?
They would make an effort to determine the functional relationships between environmental events or reinforcements and the abnormal behavior and will rely on such techniques as behavioral observation and self-monitoring behavior to identify learned maladaptive behavior.
How might a behaviorally oriented clinician assess a given client?
This would typically be a psychiatrist or medical practitioner and they would likely focus on biological assessment methods aimed at determining any underlying organic malfunctioning that may be causing maladaptive behavior.
How might a biologically oriented clinician assess a given client?
They may choose unstructured personality assessment techniques, such as Rorschach inkblots or the Thematic Apperception Test to identify intrapsychic conflicts or may simply proceed with therapy , expecting these conflicts to emerge naturally as part of the treatment process.
How might a psychodynamic or psychoanalytically oriented clinician assess a given client?
Many clinicians overemphasize personality traits as the cause of patients problems without paying enough attention to the possible role of stressors and other circumstances in the patient's life situations. Undue focus on a patient's personality can divert attention from potentially critical environmental factors.
How might underemphasis on the external situations impact assessment procedures on a patient?
Think, what do you need to know as a clinician? First- what is the presenting problem? What are the major symptoms, behavior they are experiencing, is it situational, precipitated by something, a manifestation of a more pervasive and long-term disorder, or some combination of the two, is there evidence in cognitive functioning, the duration of the complaint, how are they dealing and coping with the problem, is the person using available personal and environmental resources, is there self-defeating behavior or personality deterioration, has prior help been sought, how pervasive is the problem and how is it currently affecting important relationships, social roles, occupation or basic functioning, performance, does it fit any criteria in the DSM-5? It will also be important for clients to be able to bill their insurance so they can receive the help they need. The relationship between assessment and diagnosis is critical because clinically it will help in planning and managing appropriate treatment. Administratively, it is essential to know the range of diagnostic problems that are represented in the client population so treatment facilities can be made available to meet those needs.
Identify the basic elements in assessment:
The goals of psychological assessment include identifying and describing the individual symptoms; determining the chronicity and severity of the problems; evaluating the potential causal factors in the persons background; and exploring individuals personal resources that might be an asset in his or her treatment program.
Identify the goals in assessment:
Structured assessment interview
Interview with a set introduction that follows a predetermined set of procedures and questions throughout the process. This type of interview yields far more reliable results than the flexible format. And assessor is wise to conduct an interview that is carefully structured in terms of goals, comprehensive symptom review, other content to be explored, and the type of relationship the interviewer attempts to establish with the person. In a structured interview the beginning statements and introductions to the interview follow set procedures, the themes and questions are predetermined to obtain particular responses for all items, the interviewer cannot deviate from the question list and procedures. All questions are asked of each client in a preset way. Each question is structured in a manner so as to be quantified or clearly determined. On the negative side, structured interviews typically take longer to administer than unstructured interviews and may include some seemingly tangential questions. Clients can sometimes be frustrated by the overly detailed questions in areas that are of no concern to them.
Presenting problem- what does a clinician need to know?
Major symptoms and behavior the client is experiencing, must FIRST be identified.
MMPI-A/ MMPI-2- these provide a cost effective means of collecting a great deal of personality information rapidly.
Name the most common objectively scored personality test.
Signs
Objective observations that suggest to a diagnostician a patient's physical or mental disorder.
Self-monitoring (Used for observation methods)
Observing and recording one's own behavior, thoughts, and feelings as they occur in various natural settings. This method can be a valuable aid in determining the kinds of situations in which maladaptive behavior is likely to be evoked, and numerous studies also show it to have therapeutic benefits in its own right. A client may be asked to fill out a more or less formal self-report or a checklist concerning problematic reactions experienced in various situations. Many instruments have been published in professional literature and are commercially available to clinicians. These approaches recognize that people are excellent sources of information about themselves, assuming that the right questions are asked and that people are willing to disclose information about themselves. The results can have a crucial bearing on treatment planning.
Validity scales, clinical scales and special scales.
On table 4.1 in chapter 4, which describes the SCALES OF THE MMPI-2, what are the three scales?
Symptoms
Patient's subjective description of a physical or mental disorder.
Standardization
Procedure for establishing the expected performance range on a test. Standardization is the process by which a psychological test is administered, scored, and interpreted in a consistent or "standard" manner. Procedure for establishing the expected performance range on a test. These tests are more fair and are applied consistently and in the same manner to all those taking them. This allows the test user to compare a particular individual's score on the test with a reference population, referred to as a normative sample.
Sentence completion test
Projective personality testing technique utilizing incomplete sentences that a person is to complete, analysis of which enables a clinician to infer personality dynamics. It might help examiners pinpoint important clues to an individual's problems, attitudes, and symptoms through the content of his or her responses. However, interpretation could be subjective and unreliable. But, the test stimuli are standard, but without benefit of normative comparisons.
Cultural competence
Refers to a psychologist's need to be informed of the issues involved in multicultural assessment and to use testing procedures that have been adapted and validated for culturally diverse clients. They must ensure culturally sensitive assessment procedures.
No, it should be done as an ongoing process, and may be important at various points during treatment, not just at the beginning. For example, to examine the client's progress in treatment or to evaluate the outcome.
Should assessment only be done in the beginning?
Objective personality tests
Structured tests, such as questionnaires, self-inventories, or rating scales, used in psychological personality assessment. These are far more controlled formats than projected devices and are more objectively based quantification. One virtue of such quantification is it's precision, which enhances the reliability of test outcomes. A large number of personality assessment measures are available for use in personality and clinical assessment.
Intelligence test
Test used in establishing a subject's level of intellectual capability.
Intelligence tests, Projective personality tests, and objective personality tests.
What are the main types of psychological testing?
Psychological assessment
This refers to a procedure by which clinicians use of psychological procedures such as behavioral observations, interviews, and psychological tests to obtain a picture and summary of a client's mental health symptoms, problems and personality. The data obtained from various assessment procedures can then be integrated into a coherent clinical picture.
Projective personality tests
These are unstructured techniques that use various ambiguous stimuli such as inkblots or vague pictures rather than on explicit verbal questions, that a subject is encouraged to interpret and from which the subject's personality characteristics can be analyzed. People reveal a good deal about their personal preoccupations, conflicts, motives, coping techniques, and other personality characteristics. In trying to make sense out of vague, and unstructured stimuli, individuals project their own problems, motives and wishes into the situation. Deviant responding may be projected. These projective tests are 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.
Psychological Assessment
This would be considered the initial assessment that helps a clinician eventually arrive at clinical diagnosis according to the DSM-5. This assessment reefers to a procedure by which clinicians, using psychological tests, observation, and interviews, develop a summary of the client's symptoms and problems.
Unstructured assessment interviews
Typically subjective interviews that do not follow a predetermined set of questions. The beginning statements in the interview are usually general, and follow-up questions are tailored for each client. The content of the interview questions is influenced by the habits or theoretical views of the interviewer and the interviewer does not ask the same question of all clients; rather, he or she subjectively decides what to ask based on the clients response to previous questions. Because the questions are asked in an unplanned way, important criteria needed for a DSM-5 diagnosis might be skipped. Responses based on unstructured interviews are difficult to quantify or compare with responses of clients from other interviews. The use of unstructured interviews in mental health research is limited. On the positive side, clients may view unstructured interviews as being more sensitive to their needs or problems than more structured procedures. The spontaneous follow-up questions that emerge in unstructured interviews can, at times, provide valuable information that would not emerge in a structured interview.
Rorschach Inkblot test
Use of 10 inkblot pictures to which a subject responds with associations that come to mind. Analysis of these responses enables a clinician to infer personality characteristics. It is named after the swiss psychiatrist Hermann Rorschach (1884 to 1992), who initiated the experimental use of ink blots in personality assessment in 1911. Even though it was developed over a century ago, it is still widely used in evaluating people with mental health problems. There is a diminished use of this test and projective testing today for many reasons. It is complicated and requires considerable training. The results can be unreliable because of the subjective nature of the test interpretations. Some clinical treatments and health facilities require specific behavioral descriptions rather than descriptions of deep-seated personality dynamics. In the hands of a skilled interpreter this test can be used for uncovering certain psychodynamic issues, such as the impact of unconscious motivations on current perceptions of others. There has been an adapted for computer interpretation called the Exner Rorschach comprehensive system, a scoring and interpretation system. This has been shown though to over pathologize persons taking the test to show pathology even when the person is normal. It has been widely criticized as an instrument with low or negligible validity. Insurance companies do not pay for the considerable amount of time needed to administer, score, and interpret the test. However Rorschach remains one of the most frequently used instruments in personality assessment.
Thematic Apperception Test (TAT)
Use of a series of simple pictures about which subject is instructed to make up stories. Analysis of the stories gives a clinician clues about the person's conflicts, traits, personality dynamics, and the like. It was introduced in 1935 by its authors CD Morgan and Henry Murray at the Harvard psychological clinic. It is still widely used in clinical practice and personality research. Several scoring and interpretation systems have been developed to focus on different aspects of the subject stories such as expressions of needs, the person's perception of reality, and the person's fantasies. It is time consuming to apply the systems, and there is little evidence they make a clinically significant contribution. Most often a clinician simply makes a qualitative and subjective determination of how the story content reflects the persons underlying traits, motives, and preoccupations. Such interpretations often depend as much on "art" as on "science" and there is much room for error in such an informal procedure. It has been criticized on several grounds that the "dated" quality to the test stimuli due to pictures developed in the 1930s appear too quaint. Contemporary subjects have difficulty identifying with the characters in the pictures. It takes a great deal of time to administer and interpret. That interpretation of responses is generally subjective, which limits reliability and validity of the test. Though the TAT remains popular among practicing clinicians, clinical training programs have reduced the amount of time devoted to teaching graduate students about the TAT, and relatively few contemporary training resources exist. But those who have had long experience in the instruments use, are capable of making astonishingly accurate interpretations with TAT stories. But it is difficult teaching the skills to others because there is essentially an artistic element involved at this skill level.
Neuropsychological examination and assessment.
Use of psychological tests that measure a person's cognitive, perceptual, and motor performance to obtain clues to the extent and locus of brain damage.
This system purports to be a categorical one with sharp boundaries separating the various disorders from one another, but it is in fact a prototypal one with much fuzziness of boundaries and considerable interpenetration, or overlap, of the various categories of the disorder it identifies. Much evidence suggests that a strict categorical approach to identifying differences among types of human behavior, whether normal or abnormal, may well be an unattainable goal. The official diagnostic criteria defining the various recognized classes of mental disorder, although explicitly intended to create categorical entities, more often then not results in prototypal ones. The DSM-5 uses symptoms as the focus of classification in dividing problems into different facets. To make any diagnosis from the DSM-5 the diagnostician must observe the particular criteria- then the symptoms and signs that the DSM indicates must be met.
What approach does the DSM use is classifying abnormal behavior?
EEG (electroencephalogram), Anatomical Brain Scans (computerized axial tomography scan (CAT) and x-rays and magnetic resonance imaging (MRI)), positron emission tomography(Pet Scans) and FMRIs.
What are 5 important neurological procedures?
Interviews and behavioral observation are relatively direct attempts to determine a persons beliefs, attitudes, and problems. Psychological tests are a little more indirect means of assessing psychological characteristics. Scientifically developed psychological tests (as opposed to the recreational ones sometimes appearing in magazines or on the Internet) are standardized sets of procedures or tasks for obtaining samples of behavior.
What are psychological tests?
Because of the impact that assessment can have on the lives of others, it is important that those involved keep several factors in mind when evaluating test results: 1- potential cultural bias of the instrument or the clinician, 2- theoretical orientation of the clinician, 3- underemphasis on the external situation, 4- insufficient validation of testing, 5- inaccurate data or premature evaluation.
What are the 5 ETHICAL ISSUES IN ASSESSMENT that clinicians should be aware of when evaluating a patient's tests results?
Assessing the Presenting Problem, understanding the relationship between assessment and diagnosis, taking a good social or behavioral history, ensuring culturally sensitive Assessment procedures happen and understanding the influence of professional (theoretical) orientation, knowing the important acne of reliability, validity, and standardization the three measurement concepts that are important in understanding clinical assessment and and the utility of psychological tests and why it is important that there is great rapport and trust between the the clinician and the client.
What are the BASIC ELEMENTS to consider in ASSESSMENT?
Self-report inventories such as the MMPI have a number of advantages over other types of personality tests. They are cost-effective, highly reliable, and objective. They can also be scored and interpreted by a computer and even administered. Some of the criticisms are clinicians feel they are too mechanistic to portray the complexity of human beings and their problems accurately. It would be hard for someone who is illiterate or confused to take this test. Individuals cooperation is required and the person might distort his or her responses.
What are the advantages and limitations of objective personality tests, such as the MMPI?
Excesses, deficits and appropriateness.
What are the key dimensions to be noted or focused on when taking a SOCIAL AND BEHAVIORAL HISTORY, if the clinician is to understand the particular disorder that has brought the individual to the clinic or hospital?
Assessment interviews (should use rating scales- such as the BPRS), and clinical observation (role-playing and self-monitoring are two techniques)
What are the main elements of psychosocial assessment?
Projective Personality tests have an important place in many clinical settings, particularly those that attempt to obtain a comprehensive picture of a persons psychodynamic functioning and those that have the necessary trained staff to conduct extensive individual psychological evaluations. The great strengths of projective techniques - their unstructured nature and their focus on the unique aspects of personality - are at the same time their weaknesses because they make interpretations subjective, unreliable, and difficult to validate. It also requires a great deal of time to administer and advance skill to interpret - both scarce quantities in many clinical settings.
What are the pros and cons about projective personality tests?
Structured and unstructured interview procedures.
What are the two basic strategies in assessment by interview?
Personality factors and the social context of a client must be thoroughly evaluated.
What are the two components or ELEMENTS of taking a social or behavioral history?
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association and the (International Classification of Diseases) IDC-10 published by WHO. The DSM is the standard guide for the United States.
What are the two foremost formal psychiatric diagnostic classification systems used?
Projective test and objective tests.
What are the two types of different personality testing approaches?
Reliability, Validity and Standardization.
What are three measurement concepts that are important in understanding clinical assessment and the utility of psychological tests?
Intelligence tests and personality tests.
What are two types of psychological testing?
Rorschach Inkblot Test, Thematic Appreciation Test, and sentence completion tests.
What are types of projective personality test?
A general physical examination, a neurological examination which can include anatomical brain scans (CAT scan and MRI), EEG, Pet and fMRI.
What are ways that we can assess the physical organism?
The categorical approach, like the diagnostic system of general medical diseases, assumes 1) that all human behavior can be divided into the categories of "healthy" and "disordered," and (2) that within the latter there exist discrete, non-overlapping classes or types of disorder that have a high degree of with-in class homogeneity in both symptoms displayed and the underlying organization of the disorder identified.
What is the categorical approach to classifying abnormal behavior?
The United States is a highly diverse society that is compromised of people from multiple languages and cultural backgrounds. Today mental health practitioners find themselves engaged in a diagnostic evaluation of clients from a diverse background with marginal or limited English language skills. The client's ethnicity and cultural back ground, level of English language comprehension, religious background, and extent of their acclimation to the United States can result in incorrect appraisal of mental health symptoms. People who have not been acculturated to the environment in which they live can appear more psychologically disturbed on tests and interviews than they actually are. It is extremely important for the clinician to carefully appraise the clients background, including the values and attitudes they might bring to the interview, in order to reduce negative impact on the decision making process. The DSM five provides a structured interview that focuses on the patients approach to problems. It is called the cultural formulation interview and contains 16 questions that the practitioner can use to obtain information during a mental health assessment about the potential impact the clients culture can have on mental health care.
What cultural situations need to be taken into consideration when diagnosing people from the DSM-5?
It provides him with important behavioral information on how organic brain damage is affecting a persons present functioning.
What does Neuropsychological testing provide a clinician?
When you are conducting psychological evaluations for clients from diverse backgrounds, you must be informed of the issues involved in multi-cultural assessment and use testing procedures that have been adapted and validated for culturally diverse clients- this is often referred to as cultural competence.
What does it mean to use culturally fair assessments?
Hispanic populations (17%), African Americans (12.6 %), Asians (4.8%), Native Americans (0.9%), Native Hawaiians/ Pacific Islanders (0.2%).
What does the U.S. Census Bureau report about the current cultural minority population status?
In the origin and manifestation of mental health symptoms, gender differences have long been noted for some disorders. Some disorders show higher prevalence rate for men (such as antisocial personality disorder) than females, others (such as anorexia) are predominately found in females. Moreover, males and females who are diagnosed with the same disorder (such a conduct disorder) often show different symptoms patterns. Males have a higher rate of fighting and aggression, and females have a higher tendency to lie and be truant from school and they tend to run away from home. The DSM-5 allows for gender-related differences to be incorporated into the diagnosis.
What gender differences are taken into consideration in diagnosis?
Establishing a baseline for various psychological functions so that the effects of treatment can be measured. Criteria based on these measurements may be established as part of the treatment plan such that therapy is considered successful and is terminated only when the client's behavior meets the clients predetermined criteria.
What is another important function of pretreatment assessment?
The most widely used Minnesota Multiphasic Personality Inventory has been widely evaluated both in international applications with translated versions and in diverse sub cultural groups in the United States.
What is one of the best personality measures for various cultures?
Brief Psychiatric Rating Scale (BPRS).
What is one of the most widely used rating scales for recording observations in clinical practices and in psychiatric research?
Some psychological assessment procedures in use today have not been sufficiently validated. Widely used procedures for behavioral observation and behavioral self-report and the projective techniques have not been subjected to strict psychometric validation.
What is test validity? What happens if there is insufficient validation?
It measures a subjects ability to learn and remember material and can provide clues as to his or her judgment and impulsivity.
What is the Halstead category test on the Halsted-Reitan battery of tasks?
The initial clinical assessment would consist of the psychological assessment which after doing the procedure allows the clinician to develop a summary of the client's symptoms and problems and clinical diagnosis is the process through which a clinician arrives at a "summary classification" of the patient's symptoms by following a clearly defined system such as the DSM-5 or the ICD-10.
What is the difference between clinical diagnosis and psychological assessment?
In the dimensional approach, it is assumed that a person's typical behavior is the product of differing strengths or intensities of behavior along with several definable dimensions 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 traits, from very low to high- this is not in terms of behavioral indications of a corresponding dysfunctional presumed to underlie and give rise to a disordered pattern. Abnormality then is discriminated from normal then in terms of precise statistical criteria derived from dimensional intensities derived from a selective group of people in general, those presumed to be close to average or mentally normal. (i.e. anything above the 97th percentile or below the 3rd normative percentile could be considered abnormal findings.)
What is the dimensional approach to classifying abnormal behavior?
This may decide how a clinician might go about the assessment process. Keep in mind that a clinician's particular orientation does not have limit them to a particular assessment method or that each assessment technique is limited to a particular theoretical orientation. Certain types of assessment are more conducive than others to uncovering particular causal factors or for eliciting information about symptomatic behavior central to the understanding and treating a disorder within a given conceptual framework. Both physical and psychosocial data will be extremely important to understanding a patient.
What is the impact of professional orientation on the structure and form of a psychological evaluation?
As the DSM went through its evolution over the years it became more comprehensive and differentiated. The DSM-III of 1980 introduced a radically different approach, one that intended to remove the element of subjective judgment from the diagnostic process. It did so by adopting an "operational" method of defining the various disorders that would officially be recognized. The DSM would now specify the exact and direct observations that must be made for a given diagnostic label to be applied. A specific number of signs or symptoms must be present from a designated list before a diagnosis can be properly assigned. This continued into the next revisions which enhanced reliability and they also put ethnic and cultural considerations into the DSM-IV.
What is the meaning of reliability and validity in the context of such a classification system?
Three basic approaches are currently used to classify abnormal behavior: the categorical approach, the dimensional, and the prototypal.
What is the process for classifying abnormal behavior?
Arriving at a diagnosis is typically required, at least in the form of a "diagnostic impression," though the DSM diagnosis per se may be of limited usefulness and there is a problem of labeling. The psychiatric diagnosis of the sort typified by the DSM system are not uniformly revered among mental health professionals. A psychiatric diagnosis is little more than a label applied to a defined category of socially disapproved or otherwise problematic behavior. The label describes neither a person nor any underlying pathological condition the person necessarily harbors but, rather, some behavioral pattern associated with that person current level of functioning. A label may close of any further inquiry. It is easy to accept the label as an accurate and complete description of an individual rather than of that person's current behavior. People may make assumptions that are inaccurate and have preconceptions of how they will act. The person may accept the redefined identity and play out the expectations of that role. It can make those with the label stigmatized and treated as second class citizens with possibly permanent limitations. It can have a devastating effect on a person's morale, self-esteem, and relationships with others. A person may decide they are the diagnosis and adopt it as a career.
What is usually required before commencement of clinical services begin?
THERE MUST BE TRUST AND RAPPORT BETWEEN THE CLEINT AND THE CLINICIAN!! The client being evaluated needs to feel comfortable with the clinician, they must have trust and rapport. The client must feel that the test will help the practitioner gain a clearer understanding of their problems and must understand how the tests will be used and how the psychologist will incorporate them into the clinical evaluation. Reassure the client by always explaining to them what to expect, how the tests will be used and be helpful, and what will be done with them- let them know there is complete confidentially with the results. If released to a third party you must have consent of the client unless it is court mandated. If a test is mandated or there is not good rapport the testing relationship is likely to be strained and the persona's test taking behavior is likely to be very different form what it would be otherwise, and interpretation of the test needs to reflect this different motivational set created by the person's unwillingness to cooperate.
What must take place between the clinician and the clients in order for psychological assessment to proceed effectively and to provide a clear understanding of behavior and symptoms?
A good assessment should include a description of any relevant long-term personality characteristics. Have they responded in any deviant ways, do they have characteristics that predispose them to maladaptive ways, to they lose identity by becoming too enmeshed in others, are they so self-absorbed that intimate relationships are not possible, can they accept help from others, are they capable of genuine affection and accepting appropriate responsibility for others?
What personality characteristics are critical to understand when diagnosing an individual? (PERSONALITY FACTORS OR BEHAVIORAL HISTORY)
It is important to consider the social context in which an individual functions, what kind of environmental demands do they have, what supports or special stressors exist? The diverse and often conflicting bits of information about an individual's personality traits, behavior patters, environmental demands,must be integrated into a consistent and meaningful picture. This picture is called a "dynamic formulation" as it describes the current situation, but also includes a hypothesis about what is driving the person to behave in maladaptive ways? What will be the clients future behavior, what is the likelihood of improvement or deterioration if left untreated, what behaviors should be the initial focus of change, what treatments are best to elicit this change, how much change can be expected from this type of treatment? This treatment should be made, if possible with the collaboration, consent and the approval of the client. Knowledge of that person's strength and resources is very important. What qualities do they have that can assist improvement and, what range of factors play a role in maintaining maladaptive behavior, and final assessment may involve coordinated use of physical, psychological, and environmental assessment procedures. Depending on what facility a person goes into can vary the assessment they will recieve.
What social context needs to be considered during assessment? (SOCIAL HISTORY)
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. Typically answers are true or false. The pool of items were originally administered to a large group of normal individuals and several quite homogeneous groups of patients with particular psychiatric diagnoses. Answers to all of the items were then item-analyzed to see which ones differentiated the various groups. 10 clinical scales were constructed, each consisting of the items that were answered by one of the patient groups in the direction opposite to the predominant responses of the normal group. This is an ingenious method of selecting scoreable items, known as "empirical keying". This originated with the MMPI and doubtless accounts for much of the instruments power. It involves no subject of pre-judgment about the meaning of a true or false answer, meaning resides entirely in whether the answer is the same as the answer deviantly given by patients of varying diagnoses. Each of these 10 clinical scales thus measures tendencies to respond in psychologically deviant ways. Raw scores are compared with corresponding scores of the normal population and the results are plotted on the standard MMPI profile form. A clinician can construct a profile that shows how far from normal a patient's performance is on each of the scales. Not only does the MMPI have clinical scales which show psychopathology, it has special scales that address addictions, marital distress, hostility and PTSD, as well as validity scales that can detect how honest one is being or if they are lying or exaggerating the truth.
What validity does the MMPI offer?
For someone with suspected organic brain damage, a battery of neuropsychological tests would be recommended to determine whether or in what manner the underlying brain disorder is affecting his or her mental and behavioral capabilities
When might neuropsychological test be recommended?
In this case psychosocial assessment would be used.
When psychological difficulty is the result from non-organic causes, what assessment is used?
Because brain pathology is involved in some mental disorders it is good to run medical tests, like in instances of unusual memory deficit or motor impairments.
When would a neurological examination be recommended in client assessment?
Classification systems are important in any science, with an agreed-on classification system we can be confident we are communicating clearly. In abnormal psychology, classification involves the attempt to delineate meaningful sub-varieties of maladaptive behavior. Once we define abnormal behavior, classification of some kind is a necessary first step toward introducing order into our discussion of the nature, causes and treatment of such behavior. Classification makes it possible to communicate about particular clusters of abnormal behavior in agreed-on and relatively precise ways. It assists in research in determining the cause of disorders unless we begin with a clear definition of the behavior under examination, and we would be unable to select people whose behavior displays the aberrant patterns we hope to understand. Classification is also good for gathering statistics on how common the various types of disorders are and meeting the needs of medical insurance companies for authorizing payment of claims. Classification is the product of human intervention and is a matter of making generalizations based on what is observed and these observations go beyond mere observation and enable us to make inferences about underlying similarities and differences. Classification is an ongoing work of progress as new knowledge demonstrates an earlier generalization to be incomplete or flawed. Formal classification is successfully accomplished only through precise techniques of psychological, or clinical, assessment - techniques that have been increasingly refined over the years. It serves as a valuable guide that provides an agreed-on language that students, practitioners, and researchers can employ to enable clear communication about mental disorders. Though it is imperfect, it is indispensable.
Why is a classification system needed in abnormal psychology?
Because there are an increasing number of minorities requiring a clinical or forensic evaluation. There has been an influx of immigrants or refugees, many if whom encounter adjustment difficulties. These clients come from diverse ethnic and language backgrounds. The American Psychological Association recommends that Psychologists consider test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, linguistic and cultural differences, that might affect their judgment, reduce accuracy of interpretations and bear in mind the range of factors involved with culturally and linguistically diverse clients, ensure that the characteristics of the test being employed are appropriate across cultures and that critical bias do not interfere with critical thinking in the overall assessment process. One must consider test instrument characteristics and sociocultural factors. When using western developed tests consider appropriate cultural significance of test items, appropriate use of cultural norms, dominant language, socioeconomic status, ethnicity, and gender of their clients.
Why is it important to be culturally competent when practicing in the western United States?
The original MMPI, in spite of being the most widely used personality measure has not been without its critics. Some psychodynamically oriented clinicians felt that the MMPI was superficial and did not adequately reflect the complexities of an individual taking the test. A more specific criticism was leveled at the datedness of the MMPI. In response to these criticisms, the publisher of the MMPI sponsored a revision of the instrument. Researchers provide a strong support for the revised versions of the MMPI-2.
Why was the MMPI revised?