Abnormal Psychology: Clinical Assessment and Diagnosis

Clinical Assessment and Diagnosis

  • Clinical Assessment: Systematic evaluation of psychobiosocial factors influencing a disorder.
  • Diagnosis: Process of determining problems fulfilling criteria for a psychological disorder.

Core Principles of Assessment

  • Reliability: Consistency of measurement.
    • Inter-rater Reliability: Multiple raters get consistent results.
    • Test-retest Reliability: Same rater gets consistent results over time.
  • Validity: Whether a device measures what it's designed to do.
    • Concurrent/Descriptive Validity: Comparing assessment results with other established results.
    • Predictive Validity: How well a device assesses future outcomes.
  • Standardization: Consistent standards or norms for techniques across measurements.

Assessment Methods

Mental Status Exam/Clinical Interview

  • Systematic observation of behavior, focusing on five areas:
    • Appearance and behavior: General presentation, posture, facial expression.
    • Thought process: Coherence, organization, content of speech (e.g., loose association, delusions).
    • Mood and affect: Predominant emotional state.
    • Intellectual functioning: Vocabulary, abstraction, memory.
    • Sensorium: Awareness of surroundings.
  • Interview Types:
    • Unstructured: No systematic format.
    • Semi-structured: Careful questions, but freedom to depart.
    • Structured: Rigid questions, limited client interaction.

Behavioral Assessment

  • Direct observation of thoughts, feelings, and behavior in specific situations.
  • Operational Definition: Clarifies behavior measurement (e.g., target behavior, antecedent, consequences).
  • Self-monitoring: Individuals observe their own behavior.
  • Rating Scales: Used to assess changes (e.g., Behavior Rating Scales, Brief Psychiatric Rating Scale).
  • Reactivity: Observational data distortion due to observation affecting behavior.

Projective Testing

  • Assesses unconscious factors; relies on interpretation of ambiguous images.
  • Generally low validity and reliability.
  • Rorschach Inkblot Test: Interpreting inkblot pictures.
  • Thematic Apperception Test (TAT): Telling stories about dramatic pictures.

Personality Inventories

  • Self-report questionnaires assessing personality traits.
  • Face Validity: Wording fits described information.
  • Minnesota Multiphasic Personality Inventory (MMPI): True/false questionnaire with 550 items, generating a profile of scores.

Intelligence Testing

  • Designed to identify cognitive abilities.
  • Stanford-Binet Test: Focus on attention, perception, memory, reasoning, verbal comprehension.
  • Intelligence Quotient (IQ): Score from test factoring mental age, chronological age, and deviation from population mean.
  • Wechsler Adult Intelligence Scale (WAIS): Includes verbal and performance scales.

Neuropsychological Tests

  • Measure receptive/expressive language, attention, memory, motor skills, perceptual ability, learning, abstraction.
  • Bender Visual-Motor Gestalt Test: Copying shapes/lines to detect neurological dysfunction.
  • Halstead-Reitan Neuropsychological Battery: Includes rhythm, strength of grip, and tactile performance tests.
  • False Positives: Test shows problem where none exists.
  • False Negatives: Test shows no problem where one exists.

Neuroimaging

  • Pictures of brain structure or function.
  • Computerized Axial Tomography (CT) Scan: Uses X-rays to locate tumors, injuries, anatomical abnormalities.
  • Magnetic Resonance Imaging (MRI): Detects magnetic fields of H atoms to show lesions.
  • Positron Emission Tomography (PET): Injects radioisotope tracer to visualize blood and glucose function.
  • Single Photon Emission Computerized Tomography (SPECT): Similar to PET but less sophisticated.
  • Functional MRI (fMRI): Measures blood oxygen level dependent (BOLD) signals.

Psychophysiological Assessment

  • Measures changes in the nervous system reflecting emotional/psychological events.
  • Electroencephalography (EEG): Measures electrical activity on the scalp.
  • Galvanic Skin Response (GSR): Measures sweat gland activity (electrodermal response).

Classification Terminology

  • Classification: Constructing categories for objects/people based on shared attributes.
  • Taxonomy: Classification of entities for science.
  • Nosology: Application of taxonomy to medical/clinical domains.
  • Nomenclature: Names/labels describing disorders within a nosology.
  • Comorbidity: Diagnosis with more than one psychological disorder simultaneously.
  • Labeling: Negative connotations and stigma associated with diagnostic labels.