3. Clinical Assessment & Diagnosis

Clinical Assessment

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

Diagnosis

process where the involvement of the DSM or Diagnostic and Statistical Manual of Mental Disorder takes place

Diagnosis

identifying whether the symptoms the client is showing based of assessments is fit or meets certain criterias stated in DSM.

Validity

the appropriateness of something to actually measure something.

Reliability

the degree to which a measurement is consistent.

Standardization

the process of establishing a common set of rules or norms for a technique, ensuring consistency across different measurements or applications.

The Clinical Interview

It is the core of most clinical work used by Psychologist, Psychiatrist and other mental health professional to determine what specific problem started and identify other events that might have occurred about the same time.

1. Appearance and Behavior

2. Thought Processes

3. Mood and Affect

4. Intellectual Functioning

5. Sensorium

Mental Status Exam components

Appearance and Behavior

Mental Status Exam - includes overt behavior, attire, appearance, posture and facial expressions.

Thought Processes

Mental Status Exam - speech rate, continuity of speech, and its contents

Mood and Affect

Mental Status Exam - predominant feeling/s, state of the individual and feeling state accompanying what individual says

Intellectual Functioning

Mental Status Exam - vocabulary and its type, use of abstraction and metaphors

Sensorium

Mental Status Exam - awareness of surroundings in terms of person, time, and the place

Loose Association or Derailment

disorganized speech patterns

Delusions of Persecution

someone thinks people are after him and is going to hurt him

Delusions of Grandeur

someone thinks he/she is an almighty being or “God”

Ideas of Reference

thought pattern where a person believes unrelated events or messages are specifically about them or hold special meaning for them.

Unstructured interview style

Open-ended and conversational in nature, no predetermined questions or format

Semi-structured interview style

Have a general framework or guide with open-ended questions. Interviewer has a set of consistent topics or themes to cover, but can deviate from the guide as needed.

• Food poisoning

• Medication errors

• Underlying medical conditions

Behavioral, cognitive, or mood disorders may be linked to temporary toxic states. These toxic states can be caused by:

Behavioral Assessment

to assess an individual’s thoughts, feelings, and behavior in specific situations or contexts.

Behavioral Assessment

uses direct observation to formally assess an individual’s thoughts, feelings, and behavior in specific situations or contexts.

Informal observation

type of observation that relies on the observer’s recollection, as well as interpretation, of the events.

Formal observation

involves identifying specific behaviors that are observable and measurable (called an operational definition).

Operational definition

A precise, concrete description of a behavior or concept that specifies exactly what is to be observed and measured, so different observers can agree on what counts as the behavior.

Antecedent

The events or circumstances that occur before the behavior.

Behavior

The specific actions an individual performs during a specific situation.

Consequence

The responses an individual has to the situation, which can be based on their beliefs.

Self-Monitoring

People can also observe their own behavior to find patterns. Also called Self-Observation.

Self-Observation

Self-monitoring is also called _

Psychological testing

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.

Projective Testing

Type of psychological assessment that uses ambiguous or unstructured stimuli to uncover a person’s unconscious thoughts, feelings, desires, or conflicts.

Rorschach Inkblot Test

One of the early projective tests with 10 inkblot pictures that serve as the ambiguous stimuli, presented to the person being assessed, who responds by telling what he sees.

Comprehensive System

A standardized version of the Rorschach inkblot test specifying how the cards should be presented, what the examiner should say, and how the responses should be recorded.

Thematic Apperception Test

A projective test consisting of a series of 31 cards where the person tells a dramatic story about the picture to reveal unconscious mental processes.

Personality Inventories

Ask clients to state whether each item in a long list of statement applies to them and could ask about feelings, behaviors and beliefs.

Minnesota Multiphasic Personality Inventory

meaning of MMPI

MMPI 2

eliminates the problems with the original version, problems partly resulting from the original selective sample of people and partly resulting from the wordings of questions and adds new items dealing with contemporary issues such as type A personality, low self-esteem and family problem.

Hypochondriasis

Somatizers, possible medical problems

Depression

Dysphoric, possibly suicidal

Hysteria

Highly reactive to stress, anxious, and sad at times

Psychopathic deviate

Antisocial, dishonest, possible drug abusers

Masculinity–femininity

Exhibit lack of stereotypical masculine interests, aesthetic and artistic

Paranoia

Exhibit disturbed thinking, ideas of persecution, possibly psychotic

Psychasthenia

Exhibit psychological turmoil and discomfort, extreme anxiety

Schizophrenia

Confused, disorganized, possible hallucinations

Mania

Manic, emotionally labile, unrealistic self-appraisal

Social introversion

Very insecure and uncomfortable in social situations, timid

Intelligence Test

were developed for one specific purpose–to predict who would do well in school. A test developed that would identify “slow learners” who would benefit from remedial help.

Mental Age

IQ scores were calculated by using the child’s _ divided by the child’s chronological age and multiplied by 100 to get the IQ score.

Deviation IQ

A person’s score is compared only with score of others of the same age.

WPPSI-IV, WISC-V, WAIS IV

All these test contain verbal scales (measure vocabulary, knowledge of facts, short-term memory and verbal reasoning skills) and performance scales (assess psychomotor ability, nonverbal reasoning and ability to learn new relationship

Wechsler Preschool and Primary Scale of Intelligence – Fourth Edition

Meaning of WPPSI-IV

WPPSI-IV

An intelligence test for very young children (about ages 2 ½ – 7).

Wechsler Intelligence Scale for Children – Fifth Edition

meaning of WISC-V

WISC-V

An intelligence test for school-age children (roughly 6–16 years).

Wechsler Adult Intelligence Scale – Fourth Edition

meaning of WAIS-IV

WAIS-IV

An intelligence test for adults and older adolescents (16+ years).

Neuropsychological Testing

measure the ability in areas such as a 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 person’s performance and the possible existence of brain impairment.

Neuropsychological Testing

This method of testing assesses brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks. Although you do not see damage, you can see its effect.

• Bender Visual-Motor Gestalt Test

• Luria-Nebraska Neuropsychological Battery

• Halstead-Reitan Neuropsychological Battery

examples of neuropsychological testing

Bender Visual-Motor Gestalt Test

this test is less sophisticated than other neuropsychological test because the nature or location of the problem cannot be determined with this test.

Bender Visual-Motor Gestalt Test

can be useful for psychologist, however, because it provides a simple screening instrument that is easy to administer and can detect possible problems

Luria-Nebraska Neuropsychological Battery

a standardized battery of tests designed to identify and evaluate brain damage or dysfunction by assessing various neuropsychological functions

Luria-Nebraska Neuropsychological Battery

consists of numerous items across clinical scales that measure motor, perceptual, language, memory, intellectual, and academic skills to help determine the nature and location of brain impairment

Halstead-Reitan Neuropsychological Battery

includes the Rhythm test, Strength test, and Tactile Performance test

Rhythm test

ask to compare the sound, thus testing of sound recognition, attention and concentration

Strength test

compares the grips of the right and left hand

Tactile Performance test

requires to place wooden block in a form board while blindfolded, thus learning and memory skills

neuroimaging

a technique that has the ability to look inside the nervous system and take increasingly accurate pictures of the structure and function of the brain, using a technique

one category

category of neuroimaging with procedures that examine the structure of the brain, such as the size of various parts and whether there is any damage

secondary category

category of neuroimaging with procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic activity

1. CAT scan or CT scan

2. nuclear MRI

3. PET scan

4. SPECT

5. fMRI

6. BOLD-fMRI

examples of neuroimaging techniques

Computerized Axial Tomography (CAT) scan or CT Scan

the first neuroimaging technique, which uses multiple X-ray exposures of the brain from different angles that passes directly through the head

Computerized Axial Tomography (CAT) scan or CT Scan

It is relatively noninvasive and has proved useful in identifying and locating abnormalities in the structure or shape of the brain.

Nuclear magnetic resonance imaging (MRI)

commonly used scanning technique where the patient’s head is placed in a high-strength magnetic field through which radio frequency signals are transmitted to produce precise examination of the brain structure.

Positron Emission Tomography (PET) Scan

procedure that learns what parts of the brain are working and what parts are not.

Positron Emission Tomography (PET) Scan

supplements MRI and CT scans when localizing the sites of trauma resulting from head injury or stroke, as well as when localizing brain tumors.

Photon emission computed tomography (SPECT)

used to assess brain functioning similar to PET but is less expensive, somewhat less accurate, and requires less sophisticated equipment to pick up the signals. it is used more often than PET scans

Functional MRI (fMRI)

measures the functioning of the brain more quickly than the regular MRI and can take pictures of the brain at work, recording changes from one second to the next.

Functional MRI (fMRI)

Replaced PET scans in the leading brain imaging centers because they allow researchers to see the immediate response of the brain to a brief event, such as seeing a new face.

BOLD-fMRI (Blood-Oxygen-Level-Dependent fMRI)

most common fMRI technique used to study psychological disorders

Psychophysiological assessment

a method for assessing brain structure and function specifically and nervous system activity

Psychophysiology

measurable changes in the nervous system that reflect emotional or psychological events.

Electroencephalogram (EEG)

Measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity—brain waves come from the low-voltage electrical current that runs through the neurons. A person’s brain waves can be assessed in both waking and sleeping states

Event-Related Potential (ERP) or Evoked Potential

response to specific events, such as hearing a psychologically meaningful stimulus.

Alpha waves and Delta waves

2 types of Brain waves

Alpha Waves

pattern associated with relaxation and calmness in a normal, healthy, relaxed adult.

Delta Waves

slower and more irregular than the alpha waves, normal for the stage of sleep.

Biofeedback

levels of physiological responding, such as blood pressure readings, are fed back to the patient on a continuous basis so that the patient can try to regulate these responses.

Idiographic Strategy

what is unique about an individual’s personality, cultural background, or circumstances.

Nomothetic Strategy

determine a general class or problems to which the presenting problem belongs.

Taxonomy

classification of entities for scientific purposes

Nosology

taxonomic system in psychological or medical phenomena

Nomenclature

names or labels of the disorders that make up the nosology.

1. Classical (or pure) Categorical Approach

2. Dimensional Approach

3. Prototypical Approach

3 Classification Issues

Classical (or pure) Categorical Approach

every diagnosis has a clear underlying pathophysiological cause and each disorder is unique.

Classical (or pure) Categorical Approach

classification approach inappropriate to the complexity of psychological disorders, much more appropriate in physiological diseases

Dimensional Approach

classification approach with variety of cognitions, moods, and behaviors quantified on a scale. relatively unsatisfactory―most theorist have not been able to agree on how many of them are required

Prototypical Approach

an alternative approach that identifies certain essential characteristics of an entity. this system is not perfect for it has a greater blurring at the boundaries of categories, and some symptoms apply to more than one disorder―fuzzy