4 - Clinical Assessment and Diagnosis

• To understand the individual

• To predict behavior

• To plan treatment

• To evaluate treatment outcome

Purposes of psychological assessment:

Clinical diagnosis

the process of determining whether the individual meets the criteria for a psychological disorder

• Identification of presenting problem

• Classification of presenting problem

• Social history noting

The Basic Elements in Assessment:

Identification of presenting problem

• Situational or pervasive?

• Duration?

• Prior attempts to help or treat?

• Self-defeating or resourceful

• How does problem impact social roles?

• Does problem match any DSM-5 disorder criteria?

Classification of presenting problem

• Treatment planning

• Knowledge of range of diagnostic problem

• Insurance payment

• Personality factors

• Social context

Good assessment includes social history noting:

Detailed information

____________ helps clinicians identify potential health risks, protective factors, and cultural factors that may influence health beliefs and practices, enabling more personalized and effective care.

• Awareness of increasing population diversity

• APA ethical code related to cultural competence

• Cultural variables inclusion

Ensuring Culturally Sensitive Assessment Procedures: (3)

Professional Orientation

May determine assessment techniques

• Does not limit clinician to one type of assessment

• Reliable

• Valid

• Standardized

Psychological Assessments are:

Standardization

Ensures consistency in the use of a technique

Standardization

Provides population benchmarks for comparison

• Structured administration

• Scoring

• Evaluation procedures

Examples of Standardization:

Importance of trust & rapport > Impact on assessment process

Trust & Rapport between Clinician & Client:

• General physical examination

• Neurological examination

• Neuropsychological examination

Assessment of physical organism incorporates:

• Causal factors

• Symptom patterns

Many psychological problems have physical components either as:

• site of organic brain disorder

• extent of organic brain disorder

Neurological tests aid in determination of:

Neuropsychological examination

Involves use of expanding array of testing devices

Neuropsychological examination

Measures cognitive, perceptual, and motor performance

Neuropsychological examination

Provides clues to extent and location of brain damage

Halstead-Reitan Battery

is one of the most widely used sets of tests for assessing brain and nervous system functioning.

• Halstead Category Test

• Tactual Performance Test

• Rhythm Test

• Speech Sounds Perception Test

• Finger Oscillation Task

Halstead-Reitan Battery TESTS: (5)

• Assessment interviews

• Clinical observation of behavior

• Psychological tests

3 procedures commonly used in Psychosocial assessments include:

• Face-to-face interaction

• Structured interviews

• Unstructured interviews

Assessment Interviews:

• Mental status exam

• Semistructured clinical interviews

• Physical exam

The Clinical Interview and Physical Exam:

• Appearance and behavior

• Thought processes

• Mood and affect

• Intellectual functioning

• Sensorium

Mental status exams: (5)

• DICA (Diagnostic Interview for Children and Adolescents)

• ADIS-IV (Anxiety Disorders Interview Schedule – 4th Edition)

Semistructured clinical interviews:

Appearance and behavior

•Overt behavior • Attire •Appearance, posture, expressions

Thought processes

•Rate of speech •Continuity of speech •Content of speech

Mood & affect

•Predominant feeling state of the individual •Feeling state accompanying what individual says

Intellectual functioning

•Type of vocabulary •Use of abstractions and metaphors

Sensorium

• Awareness of surroundings in terms of person (self and clinician), time, and place-”oriented times three”

Subsequent focus

Possible existence of disorder characterized by intrusive, unwanted thoughts and resistance to them

• Clinical observation in natural environments

• Clinical observations in therapeutic or medical settings

• Use and purpose of rating scales

Clinical Observation of Behavior:

ABC Chart

a tool used to understand and track behavior, especially in behavioral psychology

• Antecedent

• Behavior

• Consequence

• Possible Function

ABC Chart:

Expanded Brief Psychiatric Rating Scale (BPRS)

Behavior Rating Scales:

• Can be either formal or informal

• Self-monitoring vs. being observed by others

• Problem of reactivity using direct observation

Behavioral observation and behavioral assessment:

• Intelligence tests

• Personality tests

2 General categories of psychological tests for use in clinical practice are:

Projective personality tests

Unstructured stimuli are presented

• Meaning or structure projected onto stimuli

Projections

________ reveal hidden motives

• Rorschach Inkblot Test

• Thematic Apperception Test

Projective personality tests include:

Herman Rorschach

10 Inkblots designed by?

Henry Murray

Thematic Approach Test (TAT) developed by?

Objective tests

Roots in empirical tradition

Objective tests

Test stimuli are less ambiguous

• Require minimal clinical inference in scoring and interpretation

• Minnesota Multiphasic Personality Inventory (MMPI)

• Extensive reliability, validity, and normative database

Personality tests:

Integration of Assessment Data

• Developing integrated, coherent working model

• Utilizing individual or team approach

• Identifying definitive picture vs. discrepancies

• Potential cultural bias

• Theoretical orientation of clinician

• Under-emphasis on external situation

• Insufficient validation

• Inaccurate data or premature evaluation

Ethical issues in assessment include:

• Introduction of order

• Communication establishment

• Prevalence rates

• Clarification of insurance issues

Benefits of classification (abnormal behavior) include:

• Categorical

• Dimensional

• Prototypal

Differing Models of Classification

• 3 basic approaches include:

• DSM-5

• DSM-5 TR

Formal Diagnostic Classification of Mental Disorders:

DSM-5

More comprehensive and more subtypes of disorders

DSM-5

Allows for gender related differences in diagnosis

DSM-5

Provides structured interview regarding cultural influences

Prolonged Grief Disorder

A new disorder added to the DSM-5-TR

Stimulant-induced Mild Neurocognitive Disorder

New disorder added to address lingering cognitive effects from stimulant use

Codes for Suicidal Behavior and Self-Injury

The DSM-5-TR includes codes for reporting suicidal and non-suicidal self-injurious behaviors without requiring a formal diagnosis.