Chapter 3 Abnormal Psych Brooke Bennett Clemson

Clinical assessment

Gathering information to make decisions about the nature, status, and treatment of psychological problems.

Clinical assessment step 1

Ask referral questions.

Clinical assessment step 2

Determine the goals of assessment by asking targeted questions.

Clinical assessment step 3

Select appropriate psychological tests and measurements.

Three primary assessment goals

Screening; diagnosis and treatment planning; outcome evaluation.

Screening

Assessment used to identify people who may have psychological problems or to predict risk of future problems.

Sensitivity

How accurately a screening test identifies people who truly have the problem; corresponds to true positives.

Specificity

How accurately a screening test identifies people who truly do not have the problem; corresponds to true negatives.

True positive

The problem is present and the screening result is positive.

False negative

The problem is present but the screening result is negative.

False positive

The problem is absent but the screening result is positive.

True negative

The problem is absent and the screening result is negative.

Diagnosis

Identification of an illness.

Differential diagnosis

Determining which diagnosis most clearly describes a patient's symptoms.

Why diagnosis matters

Diagnosis supports communication among clinicians/researchers and is important for appropriate treatment planning.

Outcome evaluation

Repeated assessment used to track progress during treatment.

Outcome assessment consistency

Useful outcome assessments should be administered consistently so change can be interpreted meaningfully.

Clinical significance in assessment

The degree to which change in a patient's symptoms is meaningful.

Misdiagnosis example: deafness

The slides note that deafness has been misdiagnosed as intellectual developmental disorder.

Misdiagnosis example: epilepsy

The slides note that epilepsy has been misdiagnosed as schizophrenia.

Misdiagnosis example: medication reaction

The slides note that medication reactions have been misdiagnosed as depression.

Misdiagnosis example: brain tumor

The slides note that brain tumors have been misdiagnosed as anorexia nervosa.

Psychometric properties

Characteristics that describe how well an assessment instrument works and how much confidence can be placed in its results.

Standardization

Evaluating scores in a consistent way so normative or self-referent comparisons are possible.

Normative comparison

Comparing a score with a representative population sample or a similar subgroup.

Self-referent comparison

Comparing a person's current responses or score with that person's own prior performance.

Standard deviation

A measure of how far scores are from the mean.

Normal curve: ±1 SD

The slide shows about 68% of scores within one standard deviation of the mean.

Normal curve: ±2 SD

The slide shows about 95% of scores within two standard deviations of the mean.

Normal curve: ±3 SD

The slide labels approximately 99% within three standard deviations of the mean.

Reliability

Consistency: how well a measure produces the same results under comparable conditions.

Test-retest reliability

Consistency of scores across time.

Interrater agreement

Consistency between different raters observing or scoring the same phenomenon.

Validity

Degree to which a test measures what it is intended to measure.

Construct validity

How accurately a measure assesses the specific construct it is supposed to assess.

Predictive validity

Ability of a measure to predict performance or outcomes at a future time.

Clinical prediction

Prediction based primarily on a clinician's judgment or interpretation.

Statistical prediction

Prediction based on statistical rules or models.

Developmental considerations in assessment

Age and developmental status should influence the selection and interpretation of assessment techniques.

Intersectionality in assessment

Considering the combined effects of race, class, gender, sexuality, religion, disability, and other identities to provide multiculturally competent services.

Clinical interview

Conversation between an interviewer and a patient that can be used for screening, diagnosis, treatment planning, and outcome evaluation.

Unstructured interview

Clinician decides what questions to ask and how to ask them; flexible but may be less reliable.

Open-ended question

Interview question that allows a broad, self-generated response.

Closed-ended question

Interview question that restricts the response to a narrower set of choices or brief answers.

Structured interview

Interview in which clinicians ask the same standardized set of questions.

Semistructured interview

Starts with standard questions but allows additional unstructured follow-up questions.

Structured interview limitation

Less flexibility than an unstructured interview.

Personality test

Assessment designed to measure personality characteristics.

Objective personality test

Personality assessment with standardized items and scoring; the slides give the MMPI as an example.

MMPI

Minnesota Multiphasic Personality Inventory, an objective personality test; the slides display an MMPI-3 profile.

Projective personality test

Assessment that uses ambiguous stimuli to elicit responses thought to reflect personality or underlying themes.

Rorschach Inkblot Test

Projective personality test using inkblot-like ambiguous stimuli.

Thematic Apperception Test (TAT)

Projective personality test listed in the slides.

General tests of psychological functioning

Measures that provide broad information about mental functioning rather than focusing on one symptom area.

General Health Questionnaire

Example in the slides of a general test of psychological functioning.

Specific symptom test

Measure focused on a particular type of symptom, such as depression or anxiety.

Beck Depression Inventory-II

Example of a specific symptom test for depression.

Beck Anxiety Inventory

Example of a specific symptom test for anxiety.

Neuropsychological testing

Assessment used to detect impairment in cognitive functioning.

Halstead-Reitan Neuropsychological Battery

Example of a neuropsychological test battery listed in the slides.

Wisconsin Card Sorting Test

Neuropsychological test listed in the slides; the slide illustrates sorting cards according to changing rules.

Intelligence testing

Assessment that produces an intelligence quotient (IQ) score.

IQ in the slides

The slides describe IQ in relation to mental age compared with age-matched peers.

Wechsler Adult Intelligence Scale

Example of an intelligence test listed in the slides.

Intelligence-testing controversies

The slides note debates about the nature of intelligence and possible bias against certain groups.

Behavioral assessment

Assessment that directly examines behavior and the contexts in which it occurs.

Functional analysis

Behavioral assessment aimed at identifying causal links between problem behavior and contextual factors.

Antecedents

Events or conditions occurring before a behavior that may influence it.

Consequences

Events or conditions occurring after a behavior that may influence its future occurrence.

Self-monitoring

Patient observes and records their own behavior as it happens.

Behavioral observation

Someone other than the patient monitors and measures behavior as it occurs.

Behavioral avoidance test

Behavioral assessment that measures avoidance in relation to a feared or difficult stimulus or situation.

Psychophysiological assessment

Measures brain structure, brain function, or nervous-system activity.

EEG

Electroencephalography; a psychophysiological assessment method listed in the slides.

Neuroimaging

Methods used to visualize brain structure or function; listed as psychophysiological assessment.

ERP

Event-related potential; a psychophysiological measure listed in the slides.

EDA

Electrodermal activity; a psychophysiological measure listed in the slides.

Biofeedback

Method that provides information about physiological activity so a person can learn to influence it.

DSM-I / DSM-1 (1952)

The slides date the first Diagnostic and Statistical Manual of Mental Disorders to 1952 and note that it established criteria for psychiatric disorders.

ICD

International Classification of Diseases and Related Health Problems; developed in Europe and used as an international standard diagnostic system.

Comorbidity

Presence of more than one disorder in the same person.

Comorbidity caution

Apparent comorbidity may reflect two distinct disorders or different manifestations of a single underlying disorder.

Developmental factors in diagnosis

Symptoms can vary by age, so developmental context should be considered in diagnosis.

Gender and diagnosis

The slides note that disorder prevalence can vary by gender.

Race/ethnicity and diagnosis

Symptoms and disorders can be influenced by race and ethnicity, and the DSM increasingly emphasizes cultural-contextual factors.

Diagnostic-system limitation: heterogeneity

People with the same diagnosis may experience different symptoms.

Diagnostic-system limitation: treatment response

People with the same diagnosis do not necessarily respond to the same treatment.

Diagnostic-system limitation: stereotypes

Diagnostic categories can encourage stereotyped conceptions of disorders.

Diagnostic-system limitation: labeling

Labels can contribute to self-fulfilling prophecies and stigma.

Diagnostic-system limitation: historical context

DSM categories can reflect the beliefs or limited knowledge of a particular era.

Diagnostic-system limitation: number of disorders

The slides list the criticism that the DSM includes too many disorders.

Dimensional model

Alternative to categorical diagnosis in which disorder symptoms are viewed as extreme variations of normal experience.

Dimensional approach benefit: richer description

Can describe patient difficulties across multiple areas of dysfunction rather than forcing a single category.

Dimensional approach benefit: poor category fit

Can better describe patients whose symptoms do not fit neatly into an existing category.

Dimensional approach benefit: heterogeneity

Can handle multiple symptoms within a diagnostic category more flexibly.

Dimensional approach criticism: communication

May make it harder to share and communicate diagnostic information.

Dimensional approach criticism: consensus

It is difficult to agree on the type and number of dimensions needed to capture the full spectrum of mental illness.

Amber clinical-research example

The slides describe Amber being screened for several concerns, randomly assigned to medication or CBT, and improving in the CBT group.