Assessing Psychological Disorders

Introduction

• Clinical assessment: systematic evaluation and measurement
  • Psychological
  • Biological
  • Social
• Diagnosis: degree of fit between symptoms and diagnostic criteria
• Purpose: understanding the individual, predicting behavior, treatment planning, evaluating outcomes

Key Concepts in Assessment

• Reliability: degree of consistency of a measurement
• Validity: does the test measure what it’s supposed to?
  • Concurrent: comparison between results of one assessment with another measure known to be valid
  • Predictive: how well the assessment predicts outcomes
• Standardization: consistent use of techniques
  • Provides normative population data

Clinical Interview

• Clinical interview: asses multiple domains
  • Presenting problem
  • Current and past behavior
  • Detailed history
  • Attitudes and emotions
• Most common clinical assessment method
• Structured vs semistructured

Mental Status Exam

• Components of mental status exam: appearance and behavior, thought processes, mood and affect, intellectual functioning, and sensorium
  • Appearance and behavior: overt behavior, attire, posture, expressions
  • Thought processes: rate of speech, continuity of speech, content of speech
  • Mood and 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

Physical Examination

• Physical examinations can be helpful in diagnosing mental health problems
  • Understand and rule out physical etiologies
  • Toxicities
  • Medication side effects
  • Allergic reactions
  • Metabolic conditions

Behavioral Assessment

• Identification and observation of target behaviors
  • Target behavior: behavior of interest
• Direct observation conducted by assessor or by individual or loved one
• Goal: determine that factors that are influencing target behaviors
• The ABCs of observation: antecedents, behavior, consequences
• Self-monitoring: when an individual observes themself
• May be informal or formal
• The problem of reactivity: simple observing a behavior may cause it to change due to the individual’s knowledge of being observed

Psychological Testing

• Specific tools for assessment of cognition, behavior, and emotion
• Include specialized areas like personality and intelligence
• Projective tests: project aspects of personality onto ambiguous test stimuli
  • Rooted in psychoanalytic tradition
  • Used to assess unconscious processes
  • Require high degree of inference in scoring and interpretation
• Objective tests: tests stimuli are less ambiguous
  • Rooted in empirical tradition
  • Requires minimal clinical inference in scoring and interpretation
• Personality tests
  • Minnesota Multiphase Personality Inventory (MMPI)
  • Extensive reliability, validity, and normative database
• Intelligence tests: nature of intellectual functioning and IQ