PSY Assessing Psychological Disorders Cap 3

What is clinical assessment?

• the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

What is diagnosis?

The process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder, as set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

What is the key features of assessment?

• Clinical begins by collecting a lot of information across a broad range of the individual’s functioning to determine where the source of the problem may lie

• After getting the overall functioning of person, the clinician narrows the focus by ruling out problems in some areas and concentrating on areas that seem most relevant

What are the three basic concepts that help determine the value of our assessments when determining psychological problems?

• Reliability

• Validity

• Standardization

assessing techniques are subject to number of strict requirements and not the least of which is some evidence that they actuallt do what they are designed to do.

What is reliability?

One of the more important requirements

• the degree to which a measurement is consistant (IE over time or among different raters)

  • raters would be the different doctors and it would be unreliable if two different doctors gave two different resuslts

• Ways to improve

  • carefully designing their assessment devices and then conducting research on them to ensure that two or more raters will get the same answers

    • CALLED INTERRATER RELIABILITY

  • Determine whether these assessment techniques are stable across time

    • If you go to a get an IQ test one day, you should expect to get the same result at a later time

    • KNOWN AS TEST RELIABILITY

What is Validity?

Whether something measures what it is designed to measure

• comparing the results of an assessment measure under consideration with the results of others that are better known allows you to begin to determine the validity of the first measure

  • This is known as CONCURRENT OR DESCRIPTIVE VALIDITY

    • IE results from a new test were the same as the results of a really long test from the bast, you could conclude that the brief version had concurrent validity

• PREDICTIVE VIDALITY

  • How well your assessment tells you what will happen in the future

    • IE who will do well in school and who wont

What is standardization?

The process by which a certain set of standards of norms is determine for a technique to make its use consistent across different measurements

• standards might apply to the procedures of testing, scoring, and evaluating data

  • IE scores on your test should be compared to people like you and not the scores of different people

What procedures and strategies do Clinicians use to acquire information they need to understand patients?

Clinical interview and within the context of interview, a mental status exam that can be administered either formally or informally( often through physical examination; a behavioral observation and assessment and psychological tests (if needed))

What happens in a clinical interview?

• It is the core of most clinical work and is used by psychologists, psychiatrists, and other mental health professionals

• gathers info on current and past behavior, attitudes, and emotions as well as a detailed history of the individuals life in general and of the presenting problem

• determine when problem started and identify events at the same time

• gather some info on patients current and past interpersonal and social history including family makeup and upbringing

• Info on sexual development, religious attitudes, relevant cultural concerns, and educational history

What is the Mental Status Exam?

Relatively brief preliminary test of a clients judgment, orientation to time and place, and emotional and mental state: typically conducted during an initial interview

Used to organize information obtained during an interview

• involves systematic observation of individuals behavior and is done when any one person interacts with another but clinicians organize their observations to give sufficient information to determine whether a psychological disorder might be present

  • IE all of us daily perfom pseudo-mental status exams

What are the five categories the Mental Status Exam covers?

1. Appearance and behavior: IE slow and effortful motor behavior (psychomotor retardation) may indicate severe depression

2. Thought processes: What is rate or flow of speech? Continuity of speech? Do they make sense when talking or no apparent connection? IE: Loose association or derailment which is disorganized speech pattern is shown in schizophrenia Content of speech? is there evidence of delusions? (Delusions of persecution where someone thinks people are after them or delusion of grandeur) (Ideas of reference in which everything everyone does somehow relates to them) Hallucinations?

3. Mood and Affect: Mood is the predominant feeling state of the individual. (down in dumps or continually elated? Depressed or hopeless?). Affect refers to the feeling that that accompanies what we say at a given point (does reaction fit what happened? Inappropriate affect if opposite reaction and blunt or flat if no reaction)

4. Intellectual functioning: reasonable vocabulary? Can they talk in metaphors? Memory? Above or Below Average Intelligence

5. Sensorium: Refers to general awareness of four surroundings. Do they know the date or time, where they are? If no problems the sensorium is “clear” and “oriented times three (person place and time)

These five observations allow to make preliminary determination of which areas of patient behavior and condition should be assessed in more detail and more formally

May begin to hypothesize which disorders might be present

After assessment, the problem reported by patient may not be the main issue

What is very important to have in clinical interview?

Trust and empathy

• psychologists trained in methods that put patients at ease and facilitate communication including nonthreatening ways of seeking information and appropriate listening skills

Information provided by patients to psychologists and psychiatrists is protected by what?

Laws of “privileged communication” or confidentiality in most states

• even if authorities want the information the therapist has received, they cannot have it without the expressed consent of patient

• only overruled when Clinician judges that because of the condition some harm of danger to either the patient or someone else is imminent

What are semistructured interviews?

Made up of questions that have been carefully phrased and tested to elicit useful information in consistent manner so that clinicians can be sure that they have inquired about the most important aspects of particular disorders

• they may depart from the questions to follow up on issues and therefore SEMI strucutred

• Because worked out over the years, people confident in its purpose

• somewhat stops spontaneous quality of who taking and if too rigid may prevent information from being given volunterily

  • Some quite specialized like the DSM 5 Anxiety and related disorders interview schedule

    • asks if plagued by obsessions or compulsions and has 9-point rating scale rating on two measures of persistence and distress and resistance

What is a physical examinations importance in psychology?

• Medical conditions sometimes associated with the specific psychological problem

• many problems presenting as disorders of behavior cognition or mood may on careful examination have clear relationship to temporary toxic state

  • bad food, medicine, or onset of medical condition

    • IE: Hyperthyroid difficulties may produce anxiety issues and hypothyroidism may give depression

• Phycologist must ascertain whether mental disorder and physical are merely coexisting or is causal looking at the onset of the problem

What does a behavioral assessment do?

takes mental status exam one step further by using direct observation to formally assess an individuals thoughts, feelings, and behavior in specific situations or contexts

target behaviors are identifies and observed with the goal of determining the factos that seem to influence them

• may be more appropriate than interview assessing individuals not old or skilled enough to report their problems and experiences

• clinician may go to persons home or workplace or even community to observe the person problem directly and others may set up roleplay

What will phyicians do in behavioral assessments without going to someones work place?

They will arrange Analogue or similar settings

• IE putting autistic children into simulated situation such as sitting at home or with sibling being asked to complete difficult to to observe selfinjurious behavior

Can also use hypnosis to produce analogue assessments by inducing symptoms of psychopathology in healthy individuals to study characteristics in a more controlled way

• IE use of ketamine

What are the ABCs of observation?

Antecedent: what happened before

behavior: the behavior

consequence: what happens afterwards

Relatively informal observation relies on the observers recollection and interpretation of the events

What is formal observation?

involves identifying specific behaviors that are observable and measurable called operational definition

• IE instead of defining as having an attitude, instead label it as any time they do not listen to what told, count the number of times it happens, what happened before and what happened after

• Goal of collecting the information is to see whether obvious patterns of behavior and then design treatment

What is self-monitoring or self-observation?

When people observe their own behavior to find patterns

• IE writing how many times you smoke and where to determine problem and what situations led them to smoke more

The goal is to help clients monitor their behavior more conveniently

When the behaviors occur only in private IE purging self-monitoring is essential as people with problem are best position to observe their own behavior

What is a formal way to observe behavior?

make checklists and behavior rating scales

behavior rating scales are used as assessment tules before treatment and then periodically during treatment to assess changes in the person behavior

What is the Brief Psychiatric Rating Scale?

An instrument for assessing a variety of behaviors (behavior rating scale)

assesses 18 general area of concern and each symptom is rated on a 7- point scale from 0 not present to 6

• screens for moderate to sever psych disorders and includes such items as somatic concern, guilt feelings, and grandiosity

What is reacitvity?

Distorts any observational data

• any time you observe how people behave, the mere fact of your presence may cause them to change behavior

• Can occur when you self-monitor increase when they want to and decrease when they don’t like what they are doing

• Clinicians sometimes depend on the reactivity of self-monitoring to increase effectiveness of treatment

What does psychological tests include?

Specific tools to determine cognitive, emotional, or behavioral responses that might be associated with a specific disorder and more general tools that assess long-standing personality features such as tendency to be suspicious

• EF intelligence testing is designed to determine the structure and patterns of cognition while neuropsychological testing determines the possible contribution of brain damage of cognitive dysfunction to the patients condition and neuroimaging uses sophisticated technology to assess brain structure and function.

What is projective testing?

a variety of methods in which ambiguous stimuli such as pictures of people or things are presented to people who are asked to describe what they see

• theory is that people project personality and unconscious fears onto people and things revealing their unconscious thoughts to the therapist

• based in psychoanalytic theory and controversial but common

• three common

  • rorschach inkblot test

  • thematic apperception test

  • sentence completion method

What is the Rorschach inkblot test?

developed by Hermann Rorsschach

• currently there are 10 inkblot pictures that serve as the ambiguous stimuli and the person responds by saying what they see

• Rorschach advocated for scientific approach to studying the answers to test but died before fully developed

• the most important part was that the test be given the same way each time according to standardized procedures

What is the Comprehensive system?

Created by john Exner and was a standardized version of the Rorschach inkblot test

• specifies how cards should be presented, what should be said, and how responses should be recorded

• varying steps led to varying responses

• still controversial

• critics question whether research on the Comprehensive system supports its use as a valid assessment technique for people with disorders

What is the Thematic Apperception Test?

Best known projective test after the Rorschach by Christiana Morgan and Henry Murray

• 31 cards, 30 with pictures and 1 blank, although only 20 cards typically used during each administration

• instructions ask the person to tell a dramatic story about picture instead of straightforward and tester says, “ this is a test of imagination, one form of intelligence” and person cal let imagination have way

• continue to be used inconsistently and still depends of the examiners frame of refrence as well as what the patient may way

What are the different versions of TAT?

• Childrens Apperception Test (CAT):

• Senior Apperception Test (SAT)

• moderations for different racial and ethnic groups changing appearance of people in pictures and also in situations depicted

Formal scoring systems of TAT stories called SOCIAL COGNITION AND OBJECT RELATIONS SCALE

Do most people who use projective tests have own methods for administration and interpretation?

YES

lack of reliability and validity make less useful as diagnostic testts

What is face validity?

The wording of questions seems to fit the type of information desired

What are Personality Inventories?

-studied by Paul Meehl

• Self report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them

• Meehl pointed out what is necessary from these types of tests is not whether the questions necessarily make sense on surface but rather what the answers to these questions predict.

  • If people with certain disorders tend as a group to answer certain questions in a certain way, this pattern may predict who else has this disorder and the content becomes irrelevant

What is the most notable personality inventories?

The minnesota Multiphasic Personality inventory

• based on empirical appreach, the collection and evaluation of data

• straightforward and is true or false

• Little room for interpretation

• very long test

• Individual responses not examined but instead the pattern to see if grouped with specific disorders and each on separate standard scale

• scored by computer

• Potential of some people to downplay problems and MMPI includes additional scales to determine the validity of each time

• creates a profile or summary of people being assessed

• one of the most extensively researched assessment instruments in psychology

• excellent at reliability but does not necessarily change how clients are treated and may not improve outcomes

What was the original MMPI made from?

People set the standard and some had no psychological disorders and some did

• sexist questions and insensitive to cultural diversity dealing with religion

• new MMPI2 added questions and revised questions

What is intelligence testing?

• to predict who will do well in school

Binet and Simon

• developed test to identify slow learners who would benefit from remedial help measuring school skills, including tests of attention, perception, memory, reasoning, and verbal comprehension

• gave to large number of children eliminating tasks that did nothing

• known as Stanford-Binet Test

What is the Stanford-Binet Test

Predict academic success

• test provided score known as intelligence quotient or IQ

• score calculated using child’s mental age

  • mental age, divided by actual age, and multiplied by 100

• Current tests now use deviation IQ

  • person score compared only with scored of others of the same age and then IQ is estimate of how much a child’s performance of others in the same age

What was Wechslet tests?

David Wechsler revised version of Stanford-Binet

• included tests of adults, children, and young children

• contained verbal scales which measure vocab, facts, short term mem, and verbal reasoning

• performance scales: assess psychomotor abilities, nonverbal reasoning, and ability to learn new relationships

What do people confuse IQ for?

Intelligence

• higher than ave does mean person has significantly greater than average chance of doing well in ed system

Problems

• may not be native language

• What really constitutes intelligence

  • test measures abilities such as attention, perception, memory, reasoning, and verbal comprehension, but do these skills represent totality of what we consider intelligence

  • may think involves more adaptation, generate new ideas, and process information

What are Neuropsychological Tests?

They measure abilities in areas such as receptive, and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction in such a way that the clinician can make educated guesses about the persons performance and the possible existence of brain impairment

• other words, assesses brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks Although you do not see brain damage, you can see effects

May be useful detecting organic damage

What is a simple neuropsychological test often used with children?

Bender Visual-Motor Gestalt Test

• child given a series of cards on which many lines and shapes drawn and asked to copy

• errors are compared with test results of other children and if the number of errors exceeds certain amount, brain dysfunction suspected

• less sophisticated with others because nature or location of problem cannot be determined with test

What are two of the most popular advanced tests of brain damage that allow more precise determinations of the location of the problem?

Luria-Nebraska Neuropsychological Battery

• includes the rhythm test where asked to compare sounds

• Strength of grip test: grips of right and left hands

• Tactile performance test: place wooden blocks on board blindfolded

and Halstead Reitan Neuropsychological battery

bother offer elaborate battery of tests to assess variety of skills in adolescents and adults and were 80 percent correct in guessing organic brain damage

What problem did neuropsychological tests bring about?

False positives and false negatives

• false results are troublesome from tests of brain dysfunction

  • fails to find damage might miss problem that needs to be treated

But routinely paired with other assessments to improve likelihood that problem will be found

What is neuroimaging?

sophisticated computer-aided procedures that allow nonintrusive examination of nervous system structure and function

divided into two categories:

• one includes procedures that examine the structure of the brain, such as the size of various parts and whether there is any damage

• second are procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic acitivity

What was the first neuroimaging technique?

Computerized Axial Tomography scan (CAT or CT scan)

developed in 1970s and uses multiple x-ray exposures of the brain from different angles but were partially blocked or attenuated more by bone and less by brain tissue

• degree of blockage picked up by detectors on the opposite side of head and picture reconstructed

• noninvasive and proved useful in identifying and locating abnormalities in the structure or shape of the brain

  • tumors, injuries, structural anomalies but risk cell damage

What is the new more used scanning technique

Magnetic Resonance Imaging MRI

• head in high magnetic field and radio signals transmitted which excite brain tissue altering protons in hydrogen atoms

• Alternation measured along with the time take to relax

• where damage is, the signal is lighter or darker

• computer can now view brain in layers and precise examination

• used to take long lime now 10 minutes

• claustrophobic people have problems

• Only recently being used to determine structural or anatomical abnormalities associated with psychological disorders

What is one procedure capable of measuring the actual functioning of the brain as opposed to structure?

PET scan

• injected with tracer attached to radioactive isotopes or group of atoms that react distinctively

• then interacts with blood, O2, glucose, etc

• when brain becomes active these substances rush to brain and create “hot spots”

• motionless for 40 seconds or more

• can be superimposed on MRI images to show precise location of active areas

• can supplement MRI and CT scans with damage

  • can look at carrying patterns of metabolism that might be associated with different disorders

    • alzheimers: reduced glucose metabolism in parietal lobes

What is the second procedure used to assess brain functioning?

Single Photon Emission Computed Tomography (SPECT)

• works like PET but different tracer used

• less accurate

• less expensive and less sophisticated equipment

• used more often than PEt

What are functional MRI?

• work more quickly

• take pictures of brain at work recording changes from one second to the next

• largely replaced PET scans because they allow researches to see immediate response of the brain to a brief event

BOLD-fMRI (Blood Oxygen Level Dependent fMRI) most common for psychological disorder

What does new neuroimaging seek to do?

view the brain all the way down to the level of the synapse

• can detect activity at the receptors for neurochemicals such as dopamine and serotonin so can differentiate activities at different and specific receptor sites

• Use radiolabeled neuroreceptor ligands (radioactive chemicals designed to congregate at specific receptor sites) in SPECT and PET imaging to study the distribution and density of neuroreceptors

What is the psychophysiological Assessment?

Way to assess brain structure and function specifically and nervous system generally

• psychophysiology refers to measurable changes in the nervous system that reflect emotional or psychological events

• measurements taken either directly from brain or peripherally from other parts of body

What is an EEG or electroencephalogram?

measures electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity

• electrodes placed directly on various places on the scalp to record the different low-voltage currents

What is an Event-related potential ERP? or envoked potential?

When brief periods of WWEEG patterns are recorded in response to specific events such as hearing a psychologically meaning stimulus

• EEG patterns often affected by psychological or emotional factors and can be an index of these reactions or a Psychophysiological measure

what are regular pattern of changes in voltage in brain called? In a normal, healthy, relaxed adult

Alpha waves

• may stress reduction treatments attempt to increase the frequency of alpha waves by relaxing patient in some way

What are the different stages of sleep and the waves?

• 1-2 hours after: delta waves

  • slower and more irregular than alpha waves

  • if frequent delta wave activity occurred during the waking state, it might indicate disfunction of localized areas of the brain

What are other psychophysiological assessment?

heart rate, respiration, electrodermal responding also known as Galvanic Skin response (GSR)

• measure of sweat gland activity controlled by the peripheral nervous system

Why is assessing psychophysiological response to emotional stimuli important for?

PTSD: sights and sounds evoke response even if not fully aware

Sexual dysfunctions and disorders

• sexual arousal assessed through direct measurement of penile circumference in males or vaginal blood flow in females in response to stimuli

Assessment and treatment of conditions such as headaches and hypertension

• form basis for treatment we call biofeedback

• reading fed back to patient so they can try and regulate response

EVEN WHEN MEASURED PROPERLY SHOW INACCURATE RESULTS bc procedural or technical difficulties or nature of response itslef

More sophisticated psychophysiological assessment is most often used in theoretical investigations of the nature of certain psychological disorders, particularly emotional disorders