Abnormal Psychology Chapter 4- Clinical Assessment and Diagnosis Study Review

In cases where physical symptoms are part of the clinical picture, a medical evaluation is recommended. Things such as physical problems, such as a psychologically based physical condition, addictive disorders, and organic brain syndromes, a variety of organic conditions, hormonal irregularities, can produce symptoms that mimic those of mental disorders that have psychosocial origins. Keep in mind though, that some long lasting pain can be related to actual organic conditions and other such pain can result from strictly emotional factors. Most clinicians insist on a medical clearance before administering psychosocially based interventions.

When would a General Physical Examination be warranted in the assessment of a client?

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.

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.

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?

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?

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.

Actuarial procedures

Methods whereby data about subjects are analyzed by objective procedures or formulas rather than by human judgements.

Forensic

Pertaining to or used in a court of law.

Depression and anxiety.

What has recent research supported as a link between resting frontal EEG asymmetry.

T-score distribution

A standard distribution of scores that allows for a comparison of scores on a test by comparing scores with a group of known values. One can evaluate if an individual's score is low, average, or high along the distribution of scores.

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:

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.

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?

Neurological Examination

Examination to determine the presence and extent of organic damage to the nervous system.

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.

Role-playing

Form of assessment in which a person is instructed to play a part, enabling a clinician to observe a client's behavior directly.

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 category test -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.

It can pinpoint sites responsible for epileptic seizures, trauma from head injury or stroke, and brain tumors. It can reveal problems that are not always apparent anatomically. In regards to pathology brain research, such as Alzheimer's may lead to important discoveries about the organic processes underlying these disorders and aide in the treatment of dementia. Therefore, it is not limited to distinguishing anatomical features such as the CAT scan is.

Give some examples of how Pet scans aid in particular diagnosis of certain brain pathology?

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:

Electroencephalogram

Graphical record of the brain's electrical activity obtained by placing electrodes on the scalp and measuring the brain wave impulses from various brain areas. The amplified impulses drive oscillating pens whose deviations are traced on a strip of paper moving at a constant speed. Significant differences from the normal patten can reflect abnormalities of the brain.

The focus would shift to the dysfunctional thoughts supposedly mediating those patterns.

How might a cognitively oriented behaviorist assess a given client?

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?

Research projects that show the results of comparison of post treatment with pretreatment assessments.

How can one evaluate the effectiveness of various therapies?

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 clinician?

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:

Magnetic resonance imaging (MRI)

Internal scanning technique involving precise measurement of variations in magnetic fields that are caused by varying amounts of water content of various organs and allows visualization of the anatomical features of internal organs, including the central nervous system and particularly the brain at any cross section at any given plane and can be computed and graphically depicted with astonishing structural differentiation and clarity.

Functional MRI (fMRI)

Internal scanning technique that measures changes in local oxygenation (blood flow) to specific areas of brain tissue that in turn depend on neuronal activity in those specific regions, allowing the mapping of psychological activity such as sensations, images and thoughts.

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.

Dysrhythmia

Irregular or abnormal brain wave pattern in the brains electrical activity (usually found on the test result of an EEG.)

Aphasia

Loss or impairment of ability to communicate and understand language symbols--involving loss of power of expression by speech, writing, or signs, or loss of ability to comprehend written or spoken language --resulting from brain injury or disease. fMRI's have disclosed that the brain activation pattern were affecting the brain's reorganization with this problem.

Presenting problem

Major symptoms and behavior the client is experiencing.

Brief Psychiatric Rating Scale (BPRS)

Objective method of rating clinical symptoms that provides scores on 18 variables (e.g., somatic concern, anxiety, withdrawal, hostility, and bizarre thinking). The BPRS provides a structured and quantifiable format for reading clinical symptoms such as over concern with physical symptoms, anxiety, emotional withdrawal, guilt feelings, hostility, suspiciousness, and unusual patterns. It contains 24 scales that are scored from ratings made by a clinician following an interview with a patient. The distinct patterns of behavior reflected in the BPRS ratings enable conditions to make a standardize comparison of their patient's symptoms with the behavior of other patients in mental health settings. The BPRS has been found to be an extremely useful instrument in clinical research, especially for the purpose of assigning patients to treatment groups on the basis of similarity and symptoms. It is not widely used for making treatment or diagnostic decisions in clinical practice.

Signs

Objective observations that suggest to a diagnostician a patient's physical or mental disorder.

Self-monitoring

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.

Comorbidity

Occurence of two or more identified disorders in the same psychologically disordered individual.

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.

Computerized axial tomography (CAT) scan

Radiological technique used to locate and rapidly assess the extent of organic damage to the brain without surgery. This is done through the use of X-rays and reveals images of the parts of the brain that might be diseased, and provide the localization and extent of anomalies in the brain's structural characteristics. The procedure involves the use of computer analysis applied to C-ray beams across sections of the patient's brain to produce images that neurologists can then interpret. The patient will be subject to ionizing radiation.

Cultural competence

Refers to a psychologist's need to be informed of the issues involved in multicultural assessment.

Positron emission tomography (PET) scan

Scanning technique that measures metabolic processes to appraise how well an organ is functioning. It provides metabolic portraits by tracking natural compounds, such a glucose, as they are metabolized by the Brian or other organs. By revealing areas of differential metabolic activity, the PET scan enables a medical specialist to obtain more clear-cut diagnosis of brain pathology.

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.

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.

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.

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?

These are situations which are designed to yield information about the persons adaptive strategies, and might involve such tasks as staged role-playing, event reenactment, family interaction assignments, or think aloud procedures. Some practitioners and researchers use a more controlled, rather than naturalistic, behavioral setting for conducting observations in contrived situations like these.

What are analogue situations?

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?

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?

These are becoming more often used over a CAT scan because the images are sharper and it has a superior ability to differentiate subtle variations in soft tissue. It is far less complicated to administer than a CAT scan and does not subject the patient to ionizing radiation. It is non-invasive and gives visualization of the most minute abnormalities of brain structure. It is really useful in confirming degenerative brain processes in large areas of the brain and can illuminate the contribution of brain anomalies to nonorganic psychoses such as schizophrenia.

What are some benefits of MRI's?

CAT scans (computerized axial tomography) and MRI scans (magnetic resonance imaging).

What are some examples of anatomical brain scans?

Anatomical brain scans

What are some more specialized techniques to assist in arriving at a more precise look into neurological problems?

It can be found in the the Old Testament when Gideon relied on the observations of his men who trembled with fear to consider whether they were fit for duty and how they chose to drink water for a stream as a means of selecting men who were ready for battle. In Ancient Rome, Tacitus provided examples in which the appraisal of a person's personality entered into their leaders judgments about them. Tacitus points out that Emperor Tiberius evaluated his subordinates in his meetings by pretending to be hesitant in order to detect what the leading men were thinking. Psychological assessment is one of the oldest and most widely developed branches of contemporary psychology, dating back to the work of Galton (1879) in the nineteenth century.

What are some of the earliest descriptions of using behavioral observation in assessing personality?

Rating scales based on contemporary diagnostic systems, the ICD-10 and the DSM-5, are available. The DSM-5 provides several rating scales, called "crosscutting symptom measures," that clinicians can use to obtain the symptom experiences of clients and for follow up evaluations of symptoms over time. The rating scales are completed by the client, the practitioner or by the parent/custodian if patient is a child or adolescent. The WHO provides a widely used rating scale for mental health and health problems, called the WHODAS 2.0.

What are some rating scales used for clinicians in a clinical setting?

Some administer a highly individualized array of tests, depending on the patient's case history and other available information. Others administer a standard set of tests that have been pre-selected to sample, in a systematic and comprehensive manner, a broad range of psychological competencies known to be adversely affected by various types of brain injury. The use of a constant set of test has many research and clinical advantages, although it may compromise flexibility.

What are the different types of Neuropsychological examinations?

They create low fidelity pictures and they are very costly because they require a very expensive instrument nearby to produce the short-lived radioactive atoms required for the procedure. Forensic use of these have been questioned even though they are allowed in court to illustrate potential brain damage.

What are the downsides to the PET scan?

In some situations and 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. They types of medical evaluation may include a general physical evaluation and special examinations aimed at assessing the structural (anatomical) and functional (physiological) integrity of the brain.

What are the factors involved with the assessment of the physical organism?

It has been used for the study of psychopathology for a number of years. Not only can it reveal brain structures like the MRI, but it can also detect brain functioning and activity. It can reveal the specific areas of the brain that appear to be involved in their neurophysiological processes. There is much optimism for the ultimate value of fMRI mapping cognitive processes in mental disorders. Some believe it may hold more promise for depicting brain abnormalities than currently used procedures such as the neuropsychological examination. fMRI has high potential for contributing to a treatment approach in mental health care. It may even be an effective procedure for detecting malingering or lying. (But has been ruled out using in court as a lie detector.) fMRI has the potential of adding to our understanding of the early development of psychological disorder. Investigators are optimistic that this procedure shows great promise for understanding brain functioning. The primary value for this procedure continues to be research into cortical activity.

What are the positive implications for the use of fMRI in brain pathology?

There are some clear methodological limitations that can influence fMRI results, it is quite sensitive to instrument errors or inaccurate observations as a result of slight movements by the patient. The results can often be difficult to interpret. Results can show patterns in cognitive impairments but do not provide much specific information about the processes studied. Some in contemporary psychiatry might be disappointed with the overall lack of effective, pragmatic methodology in fMRI assessment of cognitive processes. At this point the fMRI is not considered to be a valuable or useful diagnostic tool for mental disorders or for the use in forensic evaluations.

What are the problems with using fMRI?

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?

Reliability, Validity and Standardization.

What are three measurement concepts that are important in understanding clinical assessment and the utility of psychological tests?

Vocabulary Verbal: this sub set consists of a list of words to define that are presented orally to the individual. The task is designed to evaluate knowledge of vocabulary, which has been shown to be highly related to general intelligence. There is also the 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 and another task involves the individual remembering the numbers, holding them in memory, and reversing the order sequence saying them backwards.

What are two subsets with a brief description description of the Wechsler Adult Intelligence Scale -revised (WAIS-IV)?

Intelligence tests and personality tests.

What are two types of psychological testing?

It can cause claustrophobic reaction to being placed in a narrow cylinder that contains the magnetic field and blocks out external radio signals. There can be problems with health care policies and insurance reimbursement. MRI scans do not reveal the truth about the body that medical practices often hold and do not always lead to better outcomes.

What can be the problems with MRIs?

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?

The Hamilton Rating Scale for depression (HRSD), is a specifically targeted instrument, that is one of the most widely used procedures for selecting research subjects who are clinically depressed and also for assessing the response of such subjects to various treatments.

What is a rating scale that is more typically used in research for assessing depression?

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?

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?

It is the International Classification of Diseases, published by the World of Health Organization (WHO).

What is the ICD-10?

A pet scan tracks functioning of the brain by providing metabolic portraits by tracking natural compounds such as glucose as they are metabolized by the brain, whereas, with fMRI measures changes in local oxygenation (blood flow) of specific areas of the brain tissue which can "map" certain psychological activity, such as sensations, images and thoughts.

What is the difference between a pet scan and an fMRI?

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?

It measures the speed at which an individual can depress a lever with the index finger.

What is the finger oscillation task on the Halsted-Reitan battery of tasks?

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?

It measures attention and sustained concentration through an auditory perception task.

What is the rhythm test on the Halsted-Reitan battery of tasks?

It determines whether an individual can identify spoken words. This task measures the subject's concentration, attention and comprehension.

What is the speech sounds perception test on the Halsted-Reitan battery of tasks?

It measures a subjects motor speed, response to the unfamiliar, and ability to learn and use tactile and kinesthetic cues.

What is the tactual performance test on the Halsted-Reitan battery of tasks?

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.

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?

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?

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?

Psychological Assessment

What would be considered the initial assessment?

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?

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?